Savage.MD Blog

 There were a lot of great things that happened this week, but two in particular stand out. Wednesday I was seeing a patient in a faculty clinic. This means that the faculty member is the primary hematologist/oncologist, while I'm just a guest in the clinic for the month. I try to explain this to patients when I first meet them so they understand my role on the team. In this instance, mid-conversation with the patient, our team's nurse entered the room to draw blood. I was just about to examine the patient, when her partner asked, "Could you tell me again what your role is, doctor?" I again explained that I am a rotating physician in the faculty clinic for the month. Then the nurse spoke up for me and provided some additional context. She said "Well actually, Dr. Savage is a fellow, which means he's already a fully board certified doctor in internal medicine, but he's getting extra training in this field." This put my patient at ease, but it was also...

Today I was elected to be the next Chair of the CMA Resident and Fellow Section (RFS) . This will be my first chance to participate in a leadership position within the California Medical Association and I'm very excited.  The slate of leaders that were elected alongside me are phenomenal physicians and advocates for medicine and trainees. It's also a bit of a homecoming. I have known many of the people actively involved in the CMA-RFS for years because of our work together in the American Medical Association. I've been a proud AMA member since 2009, and the first national meeting I participated in was Fall 2009 in Houston. In 2012-2013, I was Chair of the Texas Medical Association Medical Student Section (MSS). In 2019-2020, I was Chair of the Ohio State Medical Association RFS. It'll be fun to lead now in my third state of California. Each of these positions has helped me grow as a leader, advocate for meaningful change for my colleagues, and grow my network of profess...

Today a physician mentor told me a story of some local oncologists who recently had their practice turned upside down by venture capital. It was formerly a private practice group of three physicians. One physician owned the practice. The other two physicians were employed. The owner decided to retire and rather than selling to his employees, he sold the practice to a venture capital firm. The VC firm owner is a businessperson and not a physician. The VC investor's goal was to make as much money as possible from the practice. So the VC firm shortened all the appointment slots and introduced untenable "production goals" for the employee physicians, requiring them to see a certain large number of patients per day. These are cancer  patients, some on treatment and experiencing complications. The thought of such appointments being cut short for the sake of profit broke my heart. The thought of two well-meaning physicians being forced to cut corners to make money for the VC own...

Last Monday I got the most exciting news earlier than expected. I am now a Board Certified internist! This was the culmination of three years of training in internal medicine at Cleveland Clinic and UCSD, and the next step in a lifetime of learning to be the best doctor I can be for my patients. I became "board eligible" after June 2021 when I graduated from residency at UCSD. I started to study using ACP's MKSAP in Jan 2021, but I took it up a step starting July 1 once fellowship began. I studied 2-3 hours each weeknight and spent each weekend studying throughout the two months before my exam at the end of August. By the time test day arrived, I had completed 2400 practice questions (from MKSAP and UWorld) and read each chapter of ACP's Board Basics  multiple times. I felt as ready as I could be. It was so gratifying to find out that I'm not Board Certified. Our residency class at UCSD had a 100% pass rate this year, which is a remarkable achievement for my progr...

I was discussing the natural history of a newly diagnosed cancer with a patient this week. She said "Well, I thought I'd have longer to live than that," but then said I guess "even czars get buried with a shovel."  This much is very true. No matter how successful or lives and no matter how long our lives are, all of us have one certain destiny: death. It's up to each of us to decide how we spend the precious time we have on earth. Even if you know that your life is now limited in duration by cancer, there is still much that can be done with this precious gift of time. My goal for these patients is to help palliate symptoms so that they can enjoy each and every moment. This patient's statement made me think about my father's funeral. He had a big impact on many lives. The church at his memorial was packed with friends, former coworkers, and family. We didn't talk about money or material things in his eulogy. Instead, we focused on the deep and mea...

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.