Savage.MD Blog

Yesterday I finished my first month of consults as a heme/onc fellow. Fellowship has a very different tempo than internal medicine residency. Wards and ICU rotations in residency were punctuated by early mornings where I would wake up at 5:30 am, arrive at the hospital by 6:30 am to “pre-round,” and then round formally with a team from 8:30 am to noon. Afternoons were spent calling consults, placing orders, writing notes, responding to pages, and working on placements so that patients could be discharged. Days during fellowship, on the other hand, never start before 7:30 am. Rounds on consults are in the afternoon around 3:00 pm, which gives me the day to see patients, write notes, read and learn. We rarely admit, discharge, or serve as the primary team for patients, so there are far fewer interruptions throughout the day. It’s a great pace and I feel so fortunate for my training program. I had several proud moments in the past week.  The first was a diagnosis that I helped explain...

Yesterday I checked in on a patient just before he was set to discharge home. Earlier this week I went by to talk to him in detail about his new cancer diagnosis and what the next steps in treatment might entail. It was a winding conversation. We talked about his life journey to this point and his values. I really enjoy when I have time to pull up a chair and get to know someone without being rushed by the buzz of a pager or my anxiety about the work that I still need to do. As I was leaving his room yesterday, this man said "You know, I really enjoyed our conversation a few days ago. That's the best medicine I've received since I've been here." That compliment warmed my heart and recharged my passion for my work in oncology. It was a great reminder that even simple gestures of kindness and mutual respect can themselves be therapeutic. 

Today I was asked to see a patient with a newly diagnosed cancer. We are still in the planning stages for how to best treat this person, but there was one thing that s(he) said that really struck me. "I've lived a good life." It was said with such sureness, and I understood exactly. The patient meant that s(he) had enjoyed a rich life - full of great family and memories - and that there was nothing to fear or regret in the face of cancer. I hope we can all be so lucky late in life. Each person's life experience shapes his/her goals with cancer treatment. I try to keep this in mind each time I meet a patient. Sometimes we have great treatments that can cure cancer entirely, but in many cases, there are side effects that could take awake from the quality of life. I think it's incredibly important to weigh those against a person's goals. Is having more time more important than having quality time? The answer is different for each person, and I'll never take ...

I have taken note recently of physicians in our group who make follow-up appointments with their patients to specifically discuss lab/study/imaging results. This is in lieu of calling the patient or relaying the information electronically.  I think this is a smart idea for several reasons. First, it is not uncommon for a patient to have follow-up questions. This is especially true in heme/onc where the results can be complex and sometimes life-changing. These conversations are most productive when done in a non-rushed way in a formal appointment. Second, physician time - whether it's at work or at home - is valuable. Physicians work really hard in clinic and at the hospital and need to have protected time at home to recharge. Physicians who are put in the position of using hours after work to call patients and fill out paperwork on their behalf are at a huge risk of burnout as the line between personal and professional life gets blurred. It also lessens valuable time with partners,...

As a fellow I take night call at least once per week. I've only had a hand full of call nights so far, and they've mostly been fine. We get to take call from home and most things can be responded to on the computer without going to the hospital.  Last night, I got a call from the ED letting me know that an oncology patient had been brought in by ambulance and needed to be admitted. I completely agreed and suggested that our hospital medicine team, which is in house all night, admit the patient. This is our usual practice. The hospitalist called me a half hour later and declined the admission since the patient was just recently on our service. This meant I had to go in and admit the patient myself. Around 12:30 am, just as I was climbing into bed, I got the message from our nursing team that the patient had arrived to the floor. I was at the hospital by 1:00 am. I evaluated the patient, placed admission orders, and wrote my H&P. I was back home and in bed by 3:00 am. But the...

Today I took my 8-hour initial certification exam for ABIM. This marks 10 years of me taking secure, high stakes exams for medical licensure. June 2011 - USMLE Step 1 October 2012 - USMLE Step 2 CK December 2013 - USMLE Step 2 CS October 2020 - USMLE Step 3 (2 day exam) August 2021 - ABIM Certification Exam In total, the exams above cost > $6,000 in registration fees over the years to take. And if you include the prep materials (USMLE World Question Banks, MKSAP, First Aid Textbooks, and a Doctors in Training Review Course for Step 1), it probably brings the grand total closer to $10,000. It costs a remarkable amount of money to get Certified to practice medicine.

The past two months I've been studying every evening and most weekends for a big test that's coming up next Monday. It's the certification exam in Internal Medicine for the ABIM. It cost nearly $1,500 to register for this test, so I sure do intend to pass it on my first attempt! I told one attending this week that I would be taking my Board exam next Monday. He simply shrugged and said "Well, don't worry too much. It's just a rite of passage." Clinic has been going well. I had two different patients in clinic today compliment me on my explanation of their disease and our plan for their care. They were genuine with the compliments and it meant the world to me. It's nice to get affirmation that I'm having a positive impact on the lives of others. Oncology is really a special field and I'm glad to be a part of it.