Introduction

Listen to Dr. Melvin “Sid” Dassinger, Chief of Pediatric General Surgery at UAMS, talk about his career path, surgeries he performs as a pediatric surgeon, his interests outside of medicine, and some of his most memorable moments in his medical education and surgical career. We also talk about topics like academic medicine vs. private practice as a surgeon, lifestyle as a surgeon, and what it takes to become a pediatric surgeon.

Listen to the episode

Transcript

Jasmin: So welcome to the 10th episode of Mentor Spotlight, a podcast designed to help connect UAMS medical students and faculty members. We are Jasmine and Weija – third year medical students, and your hosts for this episode. Today, we have Dr. Dassinger, a pediatric general surgeon at Arkansas Children’s Hospital. Dr. Dasinger currently serves as Chief of Pediatric General Surgery at UAMS. He has served as director of the Pediatric Surgery Fellowship at UAMS and Arkansas Children’s. He’s board certified in general surgery and pediatric surgery by the American Board of Surgery. He is a member of the American College of Surgeons, the American Pediatric Surgical Association, and the American Academy of Pediatrics.

Weija: Dr. Dassinger received his medical degree at the University of Alabama School of Medicine in 2000. He completed his surgery residency at Vanderbilt University Medical Center in Nashville and continued his training with the Pediatric Surgery Fellowship at Saint Jude Children’s Research Center in Memphis before joining UAMS and Arkansas Children’s.

Jasmin: So, we’ve already given you a brief overview of your educational background, like where you went to medical school, residency, and fellowship. But would you mind telling us more about yourself and what made you to decide this whole career path?

Dr. Dassinger: I’ve kind of always knew I wanted to be a doctor. You know? I don’t, I don’t know if you’re the same way or not. But just always what I wanted to do, and so I’ve been fortunate enough to be able to do that. Surgery, you know, it’s uh. When I was sitting in your guys’ shoes, I really liked all my rotations and we kind of did kind of the same thing that you all do. But I enjoyed pretty much all of them, but then you just kind of as you rotate back through your 4th year, you kind of, I think gravitate towards maybe a certain mindset. I think the challenge when you’re in M3 is that your rotation is very much dependent on your resident and fellow. You know who you have on service if you get along great with them, they seem really happy, then you’re like oh this is great I can do this, but then when you go back around, as a four and you start doing electives it’ll become pretty clear you know that, okay? I liked internal medicine when I was a three. I went back and did a cardiology rotation when I was a four, I was like this is terrible. I did not want to do this. I’ll go back just a little bit. So, talking about mentor groups – so we had at UAB, we just got assigned mentor groups. I had no idea what I wanted to do when I got in medical school, just happy to happy to be there. And so, I was assigned to the chief of trauma surgery, just kind of randomly. And it was M1 and M2 and M3 and M4 got assigned. And so, you know, he would say, “Hey, come make rounds with me.” So, like, in between we had test blocks. I don’t know if y’all still do or not, but like you know, every six, eight weeks we had a test and then you had a little gap and then you have tests again. After I would sometimes go over, like when he was making rounds in the trauma unit or the burn unit and go make rounds with him. And you know, he would ask you questions, but like to my knowledge, like, OK, “Is that the pancreas?” You know something like that. So, but I don’t know that may have gotten me interested in surgery a little bit early on and then it just kind of continued. So general surgery seemed like the right path for me. And then it really wasn’t until my 4th year of residency where I decided to do peids surgery. At Vanderbilt we did not, there was not a peids surgery fellowship at the time. So when you’re the 4th year resident, you ran the service, which meant you get to do all the best cases. And I can distinctly remember one weekend I was on call and I was going back to put a kid on ECMO and I’d just done a tracheoesophageal fistula. I was doing all these great cases like man, this is fantastic. This is what I want to do. And so I think, I think kind of the long lasting thing for peids surgery is it really is general surgery. Not a whole lot of that anymore. It’s unique pathophysiology that kind of takes into account the embryology. And it’s just, it’s just fun. Every case is slightly different. It feels like maybe everybody feels the same way, but there’s nuances of diseases that we see that even though you’re overall comfortable with the disease process it still challenges you when you think about how to solve those problems.

Jasmin: Dr. Burford, another pediatric surgery resident, or not resident, sorry, attending, gave us a lecture on pediatric surgery and he told us that pediatric surgery was basically the only remaining true general surgery, like subspecialty. And I think that like, I mean based on my time, like on the surface, you do like a lot of bread-and-butter cases, but then you do like a lot of really interesting cases as well. So, it’s really cool how you don’t have to just limit yourself to just a few organs. You’re able to do basically everything even as a subspecialty.

Dr. Dassinger: Yeah, I think that’s true.

Jasmin: So very, very cool. So how would you pitch this field further to a student looking into doing this?

Dr. Dassinger: Well, I mean a little bit kind of what I said, I mean that’s why I like it. But I mean, you know, when you’re in, you got shoes. I mean it’s end up having to do with what you love. I mean you have to do what do what calls to you and what stimulates you intellectually. Do things that challenge you. And then just do things that you find fun. I mean, you know there are cases that are just fun and good to do. So, I don’t know, it’s not a great pitch, but I don’t necessarily, when you’re choosing your career path I mean, there’s you can make pros and cons. You can do lists, but really, it’s your gut feeling and it’s what you choose that you want to do.

Weija: So, I haven’t done any surgery rotation yet and I was just curious what does your typical day look like? What kind of cases do you see?

Jasmin: How much clinic? How much OR?

Dr. Dassinger: Yeah, it varies in our practice. So in days where. I am not either on call or we say “surgeon of the week.” Then I would either be in clinic or doing -I do have some administrative roles that I that I have to work out – but let’s say I’m in clinic, so I’d have a full day of clinic. I would typically see a little bit more bread and butter pediatric surgery stuff. So inguinal hernias, umbilical hernias, lumps and bumps on arms and legs that people you know think should be removed.

Jasmin: Lipomas.

Dr. Dassinger: Lipomas, exactly. Then we also do like chest wall deformities. So pectus excavatum which you’ve been on the service  you probably saw that. So we’ll see, you know, clinics of that. You’ll see kids that need their gallbladder out. So you’ll see that type of stuff that’s bread and butter, that an adult surgeon would see the equivalent things in adult practice, but then we have things like chest wall deformities that are really going to be fairly peds specific. We’ll see kids and evaluate them for doing enteral feeding access so you know G tubes exactly. Things like that. So that’s what my typical clinic day would look like. The typical like on call day or surgeon of  the week day-and we do this every morning I mean, that’s one of the great things about our practice is we all sit down together every morning and run the list with our fellows. So we go to the list, we talk about the case for the day, we talk about any patients on our list  and we all it’s really constant everyday learning because you know we all learn from each other when we talk. So then go to the OR, do cases. So when you’re on call, you’re going to see things that are common for pediatric surgery, such as appendicitis, such as a disease called pyloric stenosis, such as kids that swallow things and you got to go take it out of their esophagus. That’s very, very common, you know, bread and butter pediatric surgery when you’re on call. Putting in ports and things like that for IV access. But the things that really separate a pediatric surgeon from a general surgeon would be neonatal cases. So because we have a NICU, we’re going to take care of any congenital anomalies that are not really brain or heart. You know, so what I was just talking to this guy, the guy on the phone about, was a kid that had a tracheoesophageal fistula, where the trachea and the esophagus are together, they never separated appropriately, so you have to go in and separate them. There’s a common condition called gastroschisis where all the bowels are on the outside. You got to put it back in and close, so those are things that make peds surgery very interesting. You also have neonatal, or sorry, tumors of childhood and adolescents, which, those are typically going to be seen while they’re in the hospital and operated on while they’re in the hospital. So kidney tumors or tumors of the retroperitoneum, which are called neuroblastomas.

Jasmin: Right.

Dr. Dassinger: Those are things that we would operate on and then I think lastly, one of the things that defines pediatric surgery would be diseases of the biliary tree such as choledochal cysts, such as things like biliary atresia, or tumors of the liver. So we would do those types of cases when we’re on call.

Weija: OK. Gotcha. And how often do you have to be surgeon of the week or on call?

Dr. Dassinger: So I mean that depends on your practice. You know, we’re on call about every fourth or fifth night. It can’t be as much as every three. Surgeon of the week is, you know, about the same, probably one in four, one in five, somewhere around there. Surgeon of the week is fun though. 

Jasmin: So we have like six people here?

Dr. Dassinger: We do, I mean, that’s a trickier answer because, everybody, we are general surgeons, but we probably have some niches whether or not it’s either you know another clinical realm or whether it’s administrative. So for example, one of our partners, Todd Maxson, is the surgeon and chief for the entire system, both Arkansas Children’s and Arkansas Children’s  Northwest, so he does a lot of his time there. He still likes to do trauma. And so he’ll still have some of that practice, but he has other administrative roles. I have three partners, one from northwest and then two here that are also boarded in critical care. So they’re triple-boarded peds surgery, general surgery, and critical care. And so they also work in the PICU as surgical intensivists. So and then I’m medical director of surgical quality for the hospital so that also takes up some of my time. In addition to doing other stuff. Lots of moving parts. But yeah, we have about, we have really kind of six people down here and then two in Northwest.

Jasmin: Okay. So you mentioned a lot of the procedures that you do. Are there any that you gravitate towards? You really enjoy doing?

Dr. Dassinger: Yeah, so I mean. I really love doing the neonatal cases, childhood tumors, and the biliary stuff. I mean  Kasai for biliary atresia is a great operation. Wilms tumors are great operations to do and the neonatal stuff, especially congenital lung lesions or tracheoesophageal fistulas, those are a lot of fun.

Weija: Do you have a favorite case that you can remember? Singular case.

Dr. Dassinger: Well, maybe not that I can remember. Yeah, maybe not a singular case. I mean, you, unfortunately with surgery, you probably remember the bad. You remember the hard cases and the complications. You don’t remember the ones that really, really went well. You know, I do think you remember, you know, like families can be very appreciative, I mean, if you’re able to completely remove the tumor, their child’s tumor. You know, and I mean they can be emotional, they can really be appreciative so that’s rewarding.

Weija: So I guess something that deviates a decent number of students away from surgery in general is the lifestyle. So can you tell us what your lifestyle is like? How do you balance work and life?

Dr. Dassinger: Well, I mean, everybody’s different, I mean, you know, we have these conversations. I mean, some of it can be generational. I mean, you know, everybody thinks that generation below you works less hard than you, right? I mean people felt the same way about me, you know, just the way it is.  I think general surgery residency and any sort of fellowship you do can be taxing. I mean you do have an 80 hour work week which is I know that sounds like a lot. It’s better than it was, but then I think a lot of it is the environment that you create for the working environment that you create. I mean, if you have a program that is education over service, it’s going to be more enjoyable to be a part of that, and yes, the hours are long. But you learn a lot. And while not every day is the best day, if you look back on it, I mean, I really enjoyed surgery residency and fellowship. I mean, I thought it was great. I have very good memories and I probably blocked out all the bad ones. So I mean so for that period of time, I mean, in the seven to ten year range, your time is not your own. And you just have to know that.  I don’t know what it’s like in other specialties. It’s probably similar. You know, I mean your time is not your own. But then you can have a little bit more control now in your own call and you just have to know, you know that when you’re on call, you’re going, you have to potentially be busy and (14:08) then you choose your practice based on that. You choose your practice based on what you like. And so you know, while I enjoy working with the fellows and so I mean, would I rather have a job where I was on call every fourth night where we got to work with fellows versus every eighth night where I didn’t? No, I’d still choose the one where I had to take more call but got to work with fellows because that’s rewarding. So ultimately, I mean, so you’re trying to find the right lifestyle is kind of figuring out what is meaningful for you, what’s rewarding for you, because that’s what is more lasting.

Jasmin: A genuine, like passion. Because  I’ve talked to a lot of like my classmates or my cohort that just finished surgery and a lot of us thoroughly enjoyed surgery. But then we hear from the residents, and that’s probably because the residents are actually like in the depths of their training and they’re like…don’t do it if you value lifestyle. But it’s just like… we actually really enjoyed what we did. And we’re all on pediatrics now and we’re like, oh, man, I kind of missed, like, the rush of the OR. So it’s just something that I can generally speak for myself and for other people like we are balancing and like you mentioned earlier… as you go through your third year and even your fourth year, you kind of tease out what you really want to do. 

Dr. Dassinger: Right.

Jasmin: So talking about work life balance…more leaning towards the life part. What do you like to do outside of the hospital?

Dr. Dassinger: Yeah, I like to. I like to fly fish.

Dr. Dassinger: So, you know, we’re fortunate that we have, you know, good trout fishing rivers an hour from here. And you can even do better, probably 3 hours from here, but it’s very accessible, so I like to do that. I mean, I used to like to see my kids. Kids are now in college or about the ones about to go to college. I like to hang out  with my wife, but we also we like we both like to fly fish and I like to hunt. I’ll duck hunt and turkey hunt. So I like to tie flies. I tie my own flies when we fly fish. 

Jasmin: Do you ever travel to go like fly fishing and everything?

Dr. Dassinger: Oh, yeah. Oh, sure. Yeah, yeah, yeah, I will. I’ve been. There’s a group from Children’s that has been to Alaska. I’ve been with them. My wife and I try to go once a year to Belize, and I’ll do some salt water fly fishing there.

Jasmin: It sounds like you have a very fulfilling kind of life outside of your practice. So that kind of like helps you within your practice of just centering yourself and everything. I don’t know a lot… I’ve gone fishing. I don’t know a lot about flyfishing. So, like fishing, I know is, for many people, a very relaxing activity. Yeah, I don’t know… is fly fishing the same way? 

Dr. Dassinger: It’s very relaxing. Yeah, very relaxing. But you’re constantly doing something but you’re…it’s a little bit… You have to have some patience. You have to adapt. You have to kind of, I mean it does require a little bit of a technique, so I don’t know. Fun for me.

Jasmin: You’re probably the third surgeon I know who has said they enjoy fishing or fly fishing, so I think there’s just some element, probably of relaxation.

Dr. Dassinger: Yeah, getting away.

Jasmin: Peace. 

Dr. Dassinger: Yeah, yeah, yeah.

Jasmin: OK, so now kind of moving on to greater worldly, like dreams and beliefs. So what are current frustrations that you have within your field of pediatric surgery or with medicine or healthcare in general? I know it’s a very loaded question. But we have to ask this. 

Dr. Dassinger: Yeah, yeah. Trying to think, I mean I saw that on your questions and I don’t totally know how to always know how to answer it. I mean I, you know from a… In my everyday practice standpoint, and this is, I mean it seems like a little bit of a of a self-centered answer. I mean, as you advance in the world of medicine, or especially academic medicine, you’re called on to do more and more administrative things.  And so, and sometimes that’s good. And so that sort of quality piece for me is really enjoyable. You feel like you make a difference. And then the other times the administrative stuff can kind of drag you down. And so if you allow that to pull you down too much, I think that can lead to some burnout so… but that happens with everybody. But this system that medicine has created is a little bit like that because especially academic medicine because you get advanced and advanced and advanced. So you may be, I mean, we’re not taught. I mean, you guys may be taught. I was not taught anything about business. And the other thing.

Jasmin: Oh no, we’re not.

Dr. Dassinger: About finance, I mean, I know there’s a business of medicine that Doctor Mizell does.

Jasmin: But it’s not a necessary requirement so. 

Dr. Dassinger: So, I mean, you’re exposed to things and I’m still very naive about speaking the same language that a hospital administrator would. They have a very different background than me, and so there’s some people that navigate it very, very well. I’m not sure that that’s one of my strengths, but the system that medicine has is you kind of advance and advance and advance in that way. Just kind of… I don’t know. It’s a little bit odd. Because you could… it seems like you should be prepared a little bit better or I could be prepared a little bit better. Just not my background.

Jasmin: I hope in like residency, they’re able to… a hope. I don’t know if that could actually be implemented…is that we try to learn more about the administrative side of medicine, a little bit more, but with what time?

Dr. Dassinger: It’s hard to know. 

Jasmin: I mean, yeah, really difficult.

Dr. Dassinger: I think the one good thing about Peds is that, I mean, you know, we just whoever comes in that needs something done, we just take care of them. I think in the adult world, there can be a little bit more. 

Weijia:: Hoops, insurance.

Dr. Dassinger:: Yeah, insurance. I mean, there’s that. I mean, the access to care piece. I mean, children still have a significant challenge with access to care, especially in rural state like Arkansas, but you know, just when they need help, we take care of them.

Jasmin: This kind of deviates. I promise, this is not a really controversial question, but just not listed here. What kind of geared you towards doing academic medicine as opposed to private practice?

Dr. Dassinger: Yeah, I mean, so it’s easy for me to say this in peds surgery because there are fewer peds surgery private practice gorups. I mean they exist, don’t get me wrong. But you really have to live in a bigger city. I mean, like Nashville will have one. Austin has one. Or Houston has one. But like the state of Mississippi would not have a private practice group. The state of Alabama, where I grew up, did not. So it’s a lot easier to do academic medicine and peds  surgery. All that said, I think I mean, doing the complex cases, I mean because those are kind of…get referred to a larger academic center and doing the complex cases is appealing. But then training people, I mean, training fellows. There’s probably 52-ish training programs throughout the United States for peds surgery, so we take one fellow a year. So training these people, seeing them grow from when they, you know, finish general surgery to when they completed their peds surgery. I mean, seeing that growth is extremely rewarding. And knowing that you’re training people going out there, hopefully doing good work, I think they do. That is worth a lot. 

Jasmin: At what point in your career did you decide I want to do academia? Is it when you decided to do pediatric surgery? 

Dr. Dassinger: No, you don’t really think about that until, really, you’re looking for jobs.

Jasmin: OK.

Dr. Dassinger: I mean there’s only a handful of jobs out there when you’re done. Now, I had a choice when I finished, and we all had other choices – when you get out you have other job offers and things like that. You can go practice at a place where there’s a fellowship. You can go practice at a place where there are just general surgery residents that rotate on Peds surgery, or you can  take a job that is just purely private practice, and so you could interview at those places. But ultimately, you know, decided to come here because of the fellowship.

Jasmin: Ok

Weija: So because you’ve seen a lot of fellows and a lot of students, what qualities would you say makes someone suitable for surgery or even pediatric surgery?

Dr. Dassinger: Yeah, there’s probably a common thread. I mean, so things that I look for personally, and this question gets asked a lot when people are interviewing for fellowships, right. What makes a good fellow? I think…you have to work hard. There’s no question about that and that involves, you know, reading a lot, you know, pushing yourself to learn, always. I mean, even in our position, you have to keep pushing yourself to learn. So I think that’s important for really any field. I’m not sure that it’s specific to surgery, but we have fairly high expectations when you’re on your surgery rotation. I think it’s important to be teachable. There are a lot of different ways to do things. My way is not always necessarily the best way but it is a way, and so if I can train somebody to take all the good things from everybody else in our group and apply one good thing that I’ve taught them to make them the best they can be, I think that’s beneficial for them. And I think being willing to realize you don’t know all the answers is very important. You know, so that comes along with being humble a little bit, I mean, you have to be confident in what you’re doing as a surgeon, but you also have to realize your limitations.

Weija

It’s good to hear it’s not a 250 step score.

Jasmin

The competitiveness of it, yeah.

Dr. Dassinger

Well, surgery’s gotten more and more competitive. I think it’s always been somewhat competitive, but I think general surgery is more competitive than it has ever been. And then I think Peds surgery is also quite competitive.

Jasmin

Yeah, incredibly, like what I’ve heard. So if you had any advice for listeners wanting to become a pediatric surgeon, whether they be medical students or teens in high school, what would they be? We may have touched on this a lot, but-

Dr. Dassinger

Yeah, a little bit, I mean, I think you just have to do what you like. I mean that’s…. you can’t go in it for the wrong reasons and you have to… you gotta really enjoy it because I mean I don’t know a lot about cardiology, but I said cardiology a couple of times now, but I mean, you need three years of medicine and how many years you do on the back end of training, you know, in your cardiology fellowship, you may do four years, five years, I mean so.. You got to do a lot of training whether you want to do a medical field or surgical field, you’re going to do a lot of training so you got to enjoy what you’re doing, and that’s the main thing.

Jasmin

To be able to endure the length of training, just have like an unwavering kind of drive or interest in it, honestly.

Dr. Dassinger

Yep, Yep, that’s right. I mean then you know, I mean. I don’t know. I feel lucky to feel like I’ve, you know, kind of found what that was, and I’m able to do it. I don’t think it always works that way with everybody and maybe they find it later, you know. But I think finding whatever that is that drives you..that makes you want to go back to work..that makes you want to read, you know, more about it..that sparks that curiosity. I think that’s important.

Weija

OK.

Jasmin

So what is your most memorable experience from med school, residency, or as an attending? This is a very broad question, but something that really kind of sticks out to you or you would want to talk about with people who have not experienced medicine in general.

Weija

The M1’s, the M4’s. 

Jasmin

Something that may have a really good life lesson out of it.

Dr. Dassinger

I don’t know, golly, I can think of some bad things that I mean, I won’t say bad things, but you know you can remember-

Jasmin

I mean, we’ve interviewed some surgeons who talk about very sad cases that really left a lasting impact because it is sometimes those. But of course, when we talk about it, you can, like, leave out certain details that may identify it.

Dr. Dassinger

Sure, sure. I mean, gosh, I can probably tell you.. so I was a medical student and, in between my first and second year, I was doing some research with an orthopedic surgeon, a Peds orthopedic surgeon at Childrens of Alabama, which was UAB back then. Long story short, I was in the OR kind of there helping and they wanted to cut like the pins on some on some external fixator. And they’re like, “all right, squeeze”, and I squeezed and the guy’s finger was in the back part of it, and it broke his finger. And so that was like the worst, I mean I just was absolutely mortified. So I just, like, felt incredibly terrible that I’d done something, and so I can remember that from a med student. I don’t know what the life lesson is other than you know, I..

Jasmin

..That early in your training..

Dr. Dassinger

Yeah, I mean, I went I found him the next day and it’s like, “I’m so, so sorry.” And he’s like, “oh, not a big deal, it wasn’t you” just, you know.. So, he was forgiving so that’s one thing. I mean, you have to, you have to forgive yourself a little bit and then just keep moving. I mean, because from a surgery standpoint, you’re going to..even now.. we have complications. We do everything we can to mitigate those complications. But they happen. And so you have to always kind of learn from them. so, I don’t know, there’s a whole lot of learning to be done there, but that was a terrible experience. I don’t know whether you want to put that in there or not…haha 

Jasmin

That’s fine. I mean, you’re.. You did that and you’re still a pediatric surgeon today, where as I would like..I just have sometimes a lot of anxiety. I break scrub and I feel bad, so now I can think back to this and be  like, well, Dr.Dassinger did.. And I won’t feel bad again

Dr. Dassinger

I’m trying to think of some of that. I mean, again, you remember the bad things. The good things that I mean happened..I mean, I remember just, you know, early on in my career as ..as a ped surgeon here. And we took out this big huge tumor from the back of this, you know, this big huge neuroblastoma from this kid and this kid’s dad just gives you this big, huge hug, you know. And they sent me – basically, they sent me something on my birthday, I don’t know how they found my birthday out, but sent me something on my birthday and then sent me his graduation picture. You know, so those types of things also, you know, stick with you.

Jasmin

This is kind of like a random question that I think it’s still kind of pretty relevant. Do you have any particular challenges of kind of working at like a center that is in a rural state versus working in an academic center in a more urban area like challenges, or is there anything that working in a rural state brings something unique to your practice, that you can comment on?

Dr. Dassinger

Yeah. So. I mean I think a couple of things. So I mean access to care is obviously a big deal. So you know, I just try to always be available, I mean like if the family, you know, has to get a ride somehow to be seen on a certain day, hopefully I do it and/or I encourage our service to do it. Just, you know, we’ll meet them where they… I mean, if they can get down here, you know, great, we’ll see whatever day they get down here. We’ve tried to start doing more telemedicine, which I think if you have broadband, if you can..if you have Internet…

Jasmin

..If you have internet..

Dr. Dassinger

It can be an issue. I mean that’s a real issue.

Jasmin

Oh Arkansas. Yes, absolutely.

Dr. Dassinger

…a  real problem then, then trying to do what we can there to prevent them from having to drive. I think Children’s has done a good job of trying to kind of cover the corners of the state with kind of regional hospitals or clinics to try to provide access for people. So I think there’s that component…I think Peds surgery can be regionalized just a little bit. And so you know, there’s certain things like we don’t do liver transplants here. You know those are going to be sent to St Louis or, you know, Cincinnati or somewhere kind of closer. So in Peds surgery, we are kind of a disease of the weird, you know, our special..our practice of the weird where you see all these rare things, you know, some of those things are regionalized, so you’re not going to get to do everything, but that’s OK. That’s probably best for the patients.

Jasmin

Do you ever feel like sometimes children, and you know their parents, present kind of like late in symptom severity because, you know, coming from a state with a lower health literacy and everything. Do you ever see that in your practice?

Dr. Dassinger

Yeah, I don’t..I don’t know that. I mean, yes, I’m sure we see that. How it compares I don’t know. I mean, I’ve spent time in Alabama and Tennessee. I don’t think it’s a whole lot different here than there. I think you know from a payer standpoint, you know, oh, I think between 50 to 60 percent of our patients are Medicaid. So lower socioeconomic status, but I mean, I think that’s also those are the people that need you so you know being available for them. And I think most places are like that. You know, we probably do have the patient that some people would think, like, perforated appendicitis if you wait late, then that might happen. Whether or not we have a higher rate in Arkansas than somewhere else..I’m not sure that we necessarily do, but this probably goes along the lines of socioeconomic status, probably regardless of what state you’re in.

Weija

So this is not really relevant to that, but almost every doctor I’ve talked to has always said do XYZ, like I’m doing neurology right now and the neurologist said, “always check reflexes”. You know, “always do history”. Is there an always do XYZ for Pediatrics or pediatric surgeons?

Dr. Dassinger

It’s funny, I mean, I always, I hesitate to say always but I tell the fellows that you need to listen to the mom. I just think parents, and I’d say moms because a lot of times the moms bring the kids, not that we dads don’t know. But I think I think that the moms have this innate sense that something is wrong with their baby.

Jasmin

Right.

Dr. Dassinger

That’s what I tell the fellows. I don’t say always but that they need to, they need to take that out.

Jasmin

Especially like when rounding, pre rounding. Yeah, always.

Dr. Dassinger

If the mom tells you that “I’m really worried”, uou need to listen. You know, you don’t need to blow it off.

Jasmin

So now that we’re kind of wrapping up, how can a student contact you if they wish to ask you a question, shadow you, or want to have you as a mentor.

Dr. Dassinger

They can e-mail me or-

Jasmin

E-mail you.

Dr. Dassinger

I mean or text me.

Jasmin

OK.

Dr. Dassinger

I think my phone number, I mean it’s out there somewhere.

Jasmin

Your e-mail is out there, it’s not on the Children’s site. It’s not on like your profile site for UAMS, it’s actually like on your research profile. I found it on your research profile, and so we can always, I will attach your e-mail to this transcript for anyone who would want to contact you.

Dr. Dassinger

You can certainly do that, yeah. Of course.

Jasmin

No need to give a phone number.

Dr. Dassinger

Yeah, sure.

Jasmin

I’m sure your phone is already buzzing a lot as it is.

Weija

I guess if he does research, can you talk a little bit about your research?

Jasmin

Yes, research yes, absolutely.

Dr. Dassinger

So I mean, so we have a research fellow that is usually.. OK. So most- I don’t know how much you know about surgery and the path of surgery, but most academic surgery centers, it’s five years of general surgery. Most places will do one to two years of research kind of in that, especially if you’re going to go into competitive fellowship such as Peds surgery. You know, that kind of thing, so we have a research fellow here. So we actually, I mean I’m not a strong researcher. I’ll be the first to admit that that’s just not my strength and my background, but there’s still questions that could interest you clinically, you know. And so you know, just for example, one of the things that we think about is how can we minimize opioid use or opioid prescribing for outpatient surgeries. OK. And so you know that’s been a question nationally. So not necessarily my idea, but then how do we implement it? You know, at our institution, you know, can we look at the practice patterns within our own group we probably don’t even know exist? Can we standardize that? Can we roll it out for one procedure or maybe a second procedure? Can we identify barriers to implementation? Can we overcome that? And can we make it sustainable? So those are some of the clinical, I think quality questions that interest me.

Jasmin

So does quality- do you gravitate more towards like quality improvement projects as opposed to like, I don’t know, some more specific surgical technique or procedure.

Dr. Dassinger

Yeah, I think so. I mean, I am, I’m the medical director of surgical quality here at Children’s. We’re a Level 1 verified children’s surgery center, which is similar to like Level 1 trauma centers. So we’re a level one children’s surgery center and my job is to kind of help us stay there and all that entails. And part of what part of what goes into that is looking at quality really across the board, identifying areas where we can improve and then working with groups to try to identify where they improve to do some performance improvement and then and then kind of look at it. And so that’s part of kind of what we do from a research standpoint.

Jasmin

That’s awesome. Is there anything else that we have not covered that you kind of want to talk about amongst students or whoever?

Dr. Dassinger

Probably not. I think I probably even said too much. I probably, I just, I couldn’t get the guy’s finger out of my head, but that’s that’s, I mean, that was fairly traumatic for me back in the day.

Jasmin

I hope this whole experience was very like reflective. I feel like a lot of people we interview kind of like mentioned this. You know it’s kind of nice to go back and think about.

Dr. Dassinger

No, no, I mean it’s a- I think I mean a lot of people don’t know what Peds surgery is. I mean, you know, it’s general surgery and then kind of specific things with Peds surgery. And then I don’t know I think it’s good. It’s good to get to, I mean relate these things to people that don’t come through and then everybody can get through here. So it’s good.

Jasmin

The general public too, and also people applying to like surgical residency. And like what I think, we kind of got a glimpse or hints of like what you look for in an ideal applicant so that would be extremely helpful.

Dr. Dassinger

Right. Yeah, sure.

Weija

All right.

Jasmin

So thank you so much for being available for this podcast Dr. Dassinger. And listeners, as always, reach out to us to let us know your thoughts, concerns or questions. See you all in the next episode.

Introduction

Dr. Patil is a Professor of Pediatrics at ACH/UAMS, and the Director of the Division of General Pediatrics. As a medical student, you have probably seen her through your Practice of Medicine course for which she is the current Course Director. She went to medical school in India and completed her residency at UAMS/ACH. Hear about her journey through medicine and how she was able to combine her interests in medicine and teaching by becoming an educator in addition to a clinician, while also integrating her interests outside of the hospital, from being a tennis and plant mom, to being involved with the community through dancing and fundraising. We also discuss the differences in education systems in the U.S. vs India as well as the unique challenges pediatricians face when providing care for their patients. 

Listen to Episode 7

Transcript

Manasa: It’s Mentor Spotlight, the UAMS student-made podcast to help our medical students connect with faculty mentors. This is Manasa.

Weijia: And Weijia

Manasa: And today, we are excited to have a conversation with Dr. Sowmya Patil, a pediatrician with Arkansas Children’s Hospital and UAMS. She’s a professor as well as a Director and Section Chief for General Pediatrics here.

Weijia: Dr. Patil started out for medical training in India and completed her residency right here in Little Rock. She has continued to stay involved with the Department of Pediatrics as well as both medical student education, serving as the course director of our Practice of Medicine II course. She is beloved by her residents and students, and we cannot wait for you guys to meet her so let’s get started.

Manasa: Hello Dr. Patil. How are you? 

Dr. Patil: Good? Hello, Manasa! Hello, Weijia!

 Weijia: Hi! Thank you, guys. Thank you so much for joining us today.

Dr. Patil: My pleasure. 

Weijia: Can we start off with just you telling us a little more about yourself?

 Dr. Patil: Sure. So I am Sowmya Patil. I am a pediatrician here, as you all said, and it has, it was my dream to be a pediatrician. So right… since I was seven years old, I’ve always wanted to be a pediatrician. And so, I’m born in India and grew up in India. Did my medical school in India. And so the medical school system is very different in India from here. So later on, I didn’t know it was preparing me to be a medical student director one day… but so I did my medical school in India, and then got married to my husband, who was at that time doing his masters in gerontology here in Little Rock at UALR. So we met via a matchmaking – it’s not a website. It is like place in India – like my aunt knew his mom. So they knew that we were available to get married. I guess it’s a very different concept for the generation now – it was an arranged marriage for us. It was not a love marriage, like everybody here now finds their own peer mate. So he was doing his masters in genealogy at that time here. He is also a physician, but at that time, he was doing gerontology. And so we kind of met, and I came here after I got married and finished my medical school, and I just came straight to Little Rock. I did not go to any other city, but just came to Little Rock, and as he was completing his masters in gerontology, I was doing my USMLE steps, and clinical skills and everything to get prepared for pediatrics residency, and I was also doing my observership at that time, in Little Rock at Children’s Hospital and got to work with many many beautiful mentors and wonderful people who just, you know, fueled that passion, and of pediatrics, in me more and so, and this was a great hospital, and is a great hospital to train. So, did my observerships, did my USMLEs here and then applied for residency, hoping that I would match here, and thankfully I did. And that started my residence journey over here, and 2004, I started my residency until 2007. And during that time, my husband also matched into internal medicine here, and so he was at UAMS doing his internal medicine residency.

Residency was difficult, but great, and I love this place so much that I stayed on as a faculty member in general pediatrics. In 2007, July, I started as a faculty here, and also, as I said, I was, I had always dreamed to be a pediatrician, but I also dreamed to be a teacher, so my mother used to always ask me how can you be a teacher, and a doctor at the same time?  I’d say that I don’t know, but I will figure it out- and so I had always a passion to be an educator. So when I started as a faculty here, I started as a clinical educator. So we have different tracks. We can be a clinician. Pure clinician. You can be a researcher or an educator. So there are three tracks for every faculty here. So I started as a clinical educator, and I was got in board on resident education here, to start with, and then Dr. Tariq was a friend of mine. Dr. Sara Tariq, and they had an opening, for POM for around 2014, when ICM was kind of changing to POM at that time, and one of her co-directors left – she was also pediatrician, she was my colleague, actually. And she was leaving to go back to Houston, and at that time they asked me if I would take on POM, and I was like “Yes! I want to teach so I’ll do it!” So I took over POM in 2014 as an educator, and continued my education as a pediatrician educated as pediatrician here for the pediatrics residency. And that’s how it all started. I was a clinician. I was an educator – so I could be a doctor and a teacher at the same time. 

Manasa: Hey, you found your own pathway. 

Dr. Patil: I did find my own pathway, and very grateful that I could accomplish both my dreams. Of being a doctor as well as a teacher.

Weijia: And I just wanna say, I have genuinely, really enjoyed POM 2 this year. I feel like I’m learning a lot of relevant clinical skills.

Dr. Patil: I appreciate that. Thank you so much, and thank you – you probably made my day.

[Laughs]

Manasa: So if you had to name all the job titles that you hold, we kind of mentioned them already, but can you tell us what they are, and then what they entail in terms of the clinical duties that you hold, but also the administrative sides and I guess what that how does your typical week look like.

Dr. Patil: Got it. wow! That’s a very broad question and very difficult question. But I will try to be as relevant as possible. So when I started as a student faculty, I told you there are different tracks like clinical educator tracks and an attending track. So I started on an educator track. I started as a clinical instructor in the Department of Pediatrics. So that was my first title ever as a clinical instructor, and then got promoted to Assistant Professor. Now they don’t have clinical instructor positions anymore. They start as an Assistant Professor. So I actually spent three years as a clinical instructor and as an assistant professor, also in general pediatrics. You know, I started working more with residency education. So I became the Outpatient Residency Medical Director for out-patient curriculum at that time. And that was not a title. I just gave that title to myself at that time, because we were really in the infancy of starting the curriculum for residents, and so forth. And with that I developed a lot of curriculum, and so forth. So I just kinda took over that title for myself. Then got promoted to Associate Professor at the same time I took over as POM co-course director, so I was an associate professor of Pediatrics here, and co-course director of Practice of Medicine team. And as co-course director of Practice of Medicine 2, I was helping the Dr. Tariq at that time develop the curriculum for practice of medicine, teach physical exam skills, teach the art of medicine, and so forth. That’s kind of what that entailed. Five years as an Associate Professor, and then I got promoted. I just, from Assistant Professor, I got promoted to Associate Professor after five years. And after two years of being a co-course director for POM 2, I became the course director when Dr. Tariq left POM 2. So being a course director for POM 2 is not only teaching, but education, but also a lot of administrative stuff. You know. Coordination of the curriculum, coordination with other course directors, and trying to make schedules, trying to reserve rooms and all those kind of things to have the coordinator as well. So that was my POM 2 side. As an associate professor here, I also started developing curriculums for the pediatrics residents, so increase their morning reports, didactics, or pediatric out-patient curriculum. Developed a lot of lectures for them, and then also started the first simulation course for the pediatric residents here, for physician and patient communication, so communication is my biggest passion. I love to learn communication, and teach communication. So how do you, you know, be good at a patient-physician relationship? How do you develop that rapport, and how do you go from a good doctor to a great doctor? Those are some of the skills that you know I love to learn and teach. And so that’s why I started a simulation course here, and I think that is one of the first kind of communication simulation for a residency program in the country, I think. So I looked up other places but they didn’t have a simulation course, so I learned how to do simulation as well, and I became the director for the simulation for out-patient.

At the same time, I also became the Medical Director for the teaching clinic for the pediatrics residents in our Circle of Friends Clinic. We have the continuity clinic and the teaching clinic, and so I became the director for the teaching clinic. And again, that has administrative roles and teaching roles. 

So that was Associate Professor and course director for my POM 2 course. Then I took over as Medical Director, and simulation, and all of that. Continued to be the course director, and I’m still the course director for POM 2. And this last past year, I was promoted to Professor of Pediatrics. Before that, in 2019, I was asked to take over as Chief of General Pediatrics, section chief. So I became a Section Chief of General Pediatrics. And I’m the section chief right now. So what that entails is I have 21 providers who I supervise, who are M.D.s and APRNs. We have three clinics, the general pediatric clinic in the Sturgis Building, and the Circle of Friends Clinic, which has two separate clinics, continuity and teaching. So I take care of 21 providers, three clinics, lots of residents, lots of students who kind of go through that. Lot of administrative, operations of the clinic and so forth. So currently I am a Professor of Pediatrics, Section Chief of General Pediatrics, and Course Director for Practice of Medicine. So those are all my titles and I did lots of things. And in between. I don’t know when I became the course director for the pediatrics M4 clerkship on the pediatrics side, I became the course director for the M4 longitudinal POM 2 rotation for the medical students. So again, those are all other titles that I hold for education and administrative.

So my typical week, I do three clinics, continuity clinic and teaching clinic. So I’m only in the teaching side, and the general pediatrics clinic in the Sturgis Building is only run by the providers- we do not have residents or students there. So three days of clinic- I mean not three days but three clinics. And then one and a half days of POM, and then two and a half days of administrative stuff as section chief. So that’s my week. It can change if we are short of people to take care of residents. I do more clinics. If we had to do an extra POM lecture. Sometimes, on my administrative day I do a POM lecture. So it kind of just varies. And then I, also in between asked to be the chief of adolescent medicine. So I did that for a year and a half. And now we have a new chief. So I was just babysitting that. So I was an interim. So, yeah, these are my roles, and that is my week. Very busy.

Manasa: Yeah. So many roles.

Dr. Patil: Yeah.

Weijia: It sounds like you have a successful career.

Dr. Patil: I do, and I’m very grateful for that. I never take anything for granted, because anything can change at any time. I’m kind of a person who gives 100% to anything I do. So now it’s kind of difficult to give 100% to everything. But I try my best.

Weijia: So this might be silly, but do you get to see patients, or are you mostly just working with students and residents?

Dr. Patil: I do get to see patients. I do work with students and residents, but I have to see the patients with them. So I do see patients with them, and I also have a huge panel of patients whom I see personally as well. So I take care of a lot of residents’ kids, students’ kids, nurses’ kids, other faculty kids as well. So I do see them personally, but whenever a student and resident is there in clinic, I have to see the patient with them as well. So, I do see patients, yes. And that’s one of the things I love. I love seeing patients, and I never want to give that part up.

Weijia: Yeah. What do you think would make someone a great good pediatrician? Like what qualities do you think is important?

Dr. Patil: I think it’s the same thing as every physician needs good qualities. I think good communication skills, but what a good pediatrician needs is a lot of patience and empathy because parents, it’s very difficult to be a parent. I think that the most difficult profession ever is to be a parent. So a physician or a pediatrician to understand the parents, they have to have that empathy to get into their shoes, so a pediatrician definitely needs to have a lot of patience, and a lot of empathy. And to get down to the child’s level- if you have a four year old, talk to them like a four year old, and don’t talk to them like a 15 year old. And for a 15 year old, if you talk to them like a four year old, they’re going to be like what is she talking about, you know, I I don’t want to talk to her. So that is kind of the skill that you need to have is how to be a four year old, how to be a 15 year old, and how to talk to parents like a parent, or like a doctor, and not a child. So yes, empathy, patience, and the skill to talk at their level is very important for a pediatrician. 

Manasa: So if we had to ask you about your passions within pediatrics, or within teaching specifically or within research. Are you involved with research, or any specific things other than- I know you’ve talked about POM education and teaching- but any specific topics within that as well.

Dr. Patil: I can answer the research question. I am not a researcher. I don’t know how to do research and I don’t think I like research because I think the research people need to have that specific skill to be interested in so many things. But focus on one thing, you know, I don’t think I have this skill – that part of my brain is not developed I think haha. So I do not do research, but definitely in awe of researchers who do so many good things for us. The particular specific thing, and within education is, I’m a passionate educator. Everything and anything. I find something to teach, and I love to learn and teach. But communication skills is my passion. I firmly believe that communication and good communication skills is makes or breaks any relationship – and that might be a physician, patient or peer-to-peer, student to a teacher, or even your personal relationships. So communication skills is something that I really emphasize on me. Reinforce and try to teach my residents and students. So that is kind of my passion is communication skills.

Manasa: Yeah. In terms of your passions outside the hospital then, what are you involved with outside the clinical duties that you do. And how do you relax outside of the hospital?

Dr. Patil: You won’t like this answer, but it’s very difficult for me to relax, because I am on the go all the time. But yeah, few things I have found outside of work is I have two wonderful kids – a 16 year old and a 12 year old – and they are competitive tennis players, so I’m a tennis mom. If I’m not a doctor, I’m not a teacher, I’m a tennis mom. So we travel a lot for tennis, we are on the course a whole lot for tennis. So tennis is my- ! I don’t play tennis. I’ve never held a racket in my life, but I love to see my kids play tennis, and the competitive spirit that they have. Actually we are travelling to Dallas this weekend for a tournament. So we travel a whole lot for tennis as well. So. Yes, watching my kids play tennis and being a tennis mom is the greatest pleasure I have. Apart from that, I love gardening. Spring and summer is my favorite time, because I love to grow vegetables. I have a kitchen garden. I love talking to plants. I talked to plants – I don’t know, that might be silly, but I feel that they are living too, and I love talking to plants so I love gardening. And then I love dance. I love any kind of dance. I watch a lot of dance shows. Pre-covid. I used to participate in one dance every year. And I’m involved with a lot of other cultural organizations outside of work. Lots of Indian organizations that we have lots of festivals and lots of months that probably, you know, we have lots of festivals and lots of events, and so forth. So there’s always a cultural program that I participate in. And so I love to dance. And teach dance. 

Manasa: I think many of our students, past and probably future ones, will see you help out with the Harmony fundraiser, and your performances through there. 

Dr. Patil: Yes, I have performed at Harmony multiple times, and so it’s a pleasure. I’m growing old now so maybe I’m not that agile, but I still love dance.

Manasa: It’s the passion..

Dr. Patil: It is the passion for sure, yeah. 

 Weijia: I would love to see that some day.

Dr. Patil: Sure. We can start some music now and dance. 

Weijia: So, speaking of your culture, how is maybe the Indian medical system different from the US’s? Do you think there’s anything that the US could learn from India, or vice versa? Yes, they are very different, very different, because the way I was taught and it’s not only the Indian medical system, I think I think the whole learning and teaching has changed, the paradigm has changed. Students these days learn a very different way than how we used to learn. Like I was saying, the medical school culture there is very different. What I like about, let me start with what I like about the American medical system- I think it’s more practical. It’s more real life. What you need to learn to take care of a patient. So I think it’s more practical, and hands on. The way we learnt back in India, it’s very granular, they just go to every line of the textbook. I mean, I read the whole textbook of every subject, by the time I finished my medical school, because they will ask you the most fine print questions on your test. So we had to, things that maybe not, we use very rarely in our everyday life, you know. So it’s very theoretical.

I know now it has changed to become more practical, too. So it’s a lot of theory that we learn theoretically. And then the practical applications of that is very straight, like, you know. It was a culture shock for me when I started my residency here because every time a professor or an attending used to walk in, I used to stand up, when I was a resident here. And that’s how we are taught back in medical school over there, right, anytime there is a professor or a teacher in front of you, nobody sits. We’re all standing, right, and so it was very straight. We used to know, about all the disease about everything, everything that is in textbook. If we did not answer, we used to be yelled at in front of everybody, and so that was the culture that I came from. I don’t think that’s a right way to teach, because you’re so scared all the time, and… but I thank my teachers who taught me that way because I know how to be a doctor now. There were no shortcuts that we took. But the system here as I said is more practical, and it’s more customized to the student. Right. If the student doesn’t like something, they change it. So there has to be a balance between the two. I think that is midway that we can come. That was very stringent with how we learned–it should not be like that–but it should not be as lax as it is now, too, because medical profession is a difficult profession. Anybody who comes to a medical profession needs to know that their journey is going to be long. Their journey is going to be hectic, and they going to miss out on many life events as a doctor. So knowing that, or the knowledge of that, is important as we go through our medical school journey, and not whine and grip – okay, I can’t come to this because I have to go here, and I can’t do this. I can’t do that. Or on the other side, when there was a medical school in India, we were so scared. Why don’t you allow me to sit down? What is wrong? You need to allow me to sit down and I would have been more engaged, you know.

So there are different things. But I’m grateful for what I learned. Could have been a different approach. But that has made me a stronger doctor, but I also see that nowadays the students are more practical and enthusiastic, more about doing different things and not going in the same direction, like one direction. Everybody’s chasing one direction. Now everybody wants to branch out, do different things. So that’s great. So I had to unlearn how I was taught to teach, so it was a new way of teaching for me, so I had to unlearn and then learn again, according to what students needed now. So.

Weijia: That’s almost the opposite of what we’re taught. Because we’re always told Oh, don’t be afraid to make mistakes. Don’t be afraid to ask questions. Don’t be afraid to be wrong, and from what you heard, it seems like being wrong in India, it’s like… one of the worst things ever…

Dr. Patil: Oh, it is one of the worst things that can happen. 

Weijia: Oh wow

Dr. Patil: We were scared to ask questions. That’s why I said. I don’t think. –

Weijia: We are scared too, haha.

Dr. Patil: But you know, I think it is very good now a days that if you think it’s wrong, or if you, they’re not as hesitant to ask questions these days, sometimes I feel oh, my gosh! If I was in the students place, I could have never dared to ask for my teacher that question. But, I feel good now that students are asking that, because it’s always good- I always say no question is a stupid question. If you don’t know something, clarify, you know.

But we were so scared when I was a medical student but if you just ask a question, you really don’t know this and that’s why you’re asking me, I’m like, yes, I don’t know that I’m asking you -you should know this, I mean we felt, made to feel very small, that you don’t know this kind of thing, but I guess that was a way of teaching there, which I don’t endorse worse at all. But I guess because of that I was always alert and read everything, and studied everything, and I was always like on task, you know. But. It’s different. Yeah. But again, never hesitate to ask questions, always ask questions, because at the end of the day, you, the knowledge you gain, especially in medical school, it’s going to be used on a patient. So it’s always good to be clear and clarify things, and no questions is a stupid question. For sure.

Weijia: Do you have any other advice? For you know either med students or students wanting to be pediatrician in the future.

Dr. Patil: In general, I would tell all med students keep an open mind. Every day, come with an open mind to learn. Cause every patient you meet, you learn from your peers, you learn from your patient, you learn from your teachers, you learn from each other. You are always learning, after so many years of practice, I learn every day from my patients. I learn from my residents and students. I’m like, wow, that’s such a great way of thinking over something, you know. Cause I’m so, we are so, used to thinking in a certain way, we have done this for 20 years, and I’m like, Okay, I know how to do this. And this has worked for me. I’ll do. But then suddenly a student comes and says, I do it this way. Why not this way? I’m like, yes, that is such a great idea. Yeah. And that’s why I like teaching, is because I always learned from everybody. Come with an open mind. And do not shy to learn. Do not hesitate to ask questions and learn because there is so much to learn out there. And half the things you learn in medical school, you forget. 

[Laughs]

Dr. Patil: You will forget haha! Cause as you start branching out into a particular interest of yours, like a anesthesiology or cardiology, whatever, you won’t remember the Krebs Cycle. I can never remember the Krebs Cycle. That’s one thing I can never remember. But what I’m saying is, yes, keep an open mind. Learn, for all med students. And in pediatrics, as I said, have that patience and empathy, you really needed. You really need it. Yeah, and have children! So that you can be a better pediatrician. 

 [Laughs]

Manasa: I guess if someone is interested in pediatrics, you’ve stayed general pediatrician. But how would you describe the different fellowships available to them? And how they can make the decision of whether they should or shouldn’t pursue a fellowship? And what would be best, and for their interests, but also their career interests?

Dr. Patil: Sure. Yes, there are many pediatric fellowships. And again, if this is something very personal that everybody decides on whether to go to fellowship or not, and to each his own, you know. I decided to say stay general pediatrics, but I wanted to be a neonatologist. I really wanted to be an neonatologyist because I love babies. I love my nursery rotation, and the NICU rotation here. But then life changed for me, because when I had my daughter, I wanted to be a mom. And you know, and I wanted to have regular hours, I wanted to work Monday to Friday, I did not want to work on weekends. I didn’t want to be on overnight calls, because it changed that I wanted to be mom also along with being a doctor. So at that time I was like, you know what I could do general pediatrics. I could see all, I could see babies as a general pediatrician, and if later on, I want to be a nursery and a general pediatrician, I can work in a nursery also. And I want to have normal hours in a day. That was my priority. Having normal hours in a day, not to take overnight calls, to be free on my weekends for my kids, and that’s when I chose general pediatrics. So I was actually between general pediatrics and neonatology. No other specialty interested me as much. So that is why I decided to be a general pediatrician is because I wanted normal hours, and I wanted to be a mom as well, and I knew that being a sub-specialist would take more time away from my family for me. So I wanted to balance both.

But there are many fellowships, or if you’re interested in, for example, allergy and immunology. It’s a great fellowship to have a good work like balance as well. Right, but then you follow your passion. Okay, if your passion is cardiology, if your passion is neonatology, and you think you can do it, and 10 years from now, you’ll not regret that decision, do it! So that’s how, and if you want to do a fellowship and it’s three more years of training. So, are you ready commit yourself to three more years of training after a general pediatrics residency? If that’s yes, is an answer, and you are going to accept the consequence of training for another three years, go for it. Okay, so follow your passion. Make sure what your priorities are. Like for me, I wanted to be mom as well as a teacher as well as a doctor. So what was the right balance for me at that time was going into general pediatrics. 

There are lots of fellowships here. If students want to, are interested in an allergy fellowship, or a cardiology, neonatology. There’s a very good peds honors program, that you know, starting in your first year, you can apply for it, and you can, you’re assigned to a preceptor or a faculty here that you can do a project with in your area of interest. And so that’s a good way of starting out. Doing rotations or observerships with anybody in the field of your choice within some specialty like a peds cards, peds pulmonology, peds GI, during your summer break, or something, if you want to do observership, that’s another great way of getting more insight into what they do. Or when you start your third year clerkships, right? You rotate through all the rotations, and figuring out, what’s best for you. I have had many students who wanted to be a cardiologist, but at the end of, or wanted to do internal medicine. And, by the end of their rotations, turned out to be a pediatrician. I want to do pediatrics. Or started off as pediatrics and went into OBGYN. You know, so things change. But again, talk to many faculty. Introduce yourself to people, that area that you want to work in. Right, talk to them, shadow them, learn from them. So that’s how I would say.

Weijia: Oh, what is your favorite part about being a pediatrician? And your least favorite part about being a pediatrician. 

Dr. Patil: [Laughs.] Favorite part is the kids, for sure. I love precocious four year-olds and five year-olds. I can chat with them the whole day. I mean, the satisfaction and the fulfillment I get out of talking to these kids. About their day. About the small things, and then they’re so happy, you know, with the small things – the one cartoon character, or one toy they have. I love that happiness and satisfaction that they have. I always want to be like them. So those 10 minutes, 15 minutes I spend with them. I become them, or I become like them. So that’s the best part of being a pediatrician.

The worst part are the parents. I wouldn’t say the worst part, but it’s challenging, because the parents, like mom, dad, this is what you need to do, right? This is what will help you. No, I don’t want to do this. I want to do this! Or trying to change them, change their mindset. And to reassure them. There are many things in pediatrics where we don’t do anything. We just wait and watch. So how do you tell a parent, “Just wait and watch your kids suffer,” right? It’s a viral infection, it’s going to be there for five days. Watch them, they will go away. 

So trying to deal with the parents is challenging in pediatrics. I wouldn’t say it’s my least favorite, but that is the most challenging part for me, is, and that’s why I won’t like being an adult doctor, because that’s going to be my everyday life. Yeah, but at the same time, once you try to be on the same page, or convince and reason with the parents, because it is for their kids, they will do it unlike adults who will never listen to you, I guess, I don’t know. But yeah. That’s the most challenging part. Ah, but for the most part, I can talk to them, play with that, and then give it back to the parents. I don’t have to take it home.

Weijia: One of our friends who wants to be a pediatrician always says kids are the only humans she approve of. And I think..

Dr. Patil: I want to meet that person, because I totally agree with that. Yes, they are the only humans I will approve of. But then, when they become 17 and 18.. Ugh

Weijia: They’re not kids anymore. They’re teenagers.

Dr. Patil: Yeah, that’s a different story. For another day. That’s challenging, too. 

Manasa: Each age group has its own challenges and yes, mindset, like you were saying earlier…

Dr. Patil: Yes absolutely, and there is no other h- creature like a teenager. I would say they are so different. And I think I feel that the least understood too. Everybody’s like. Oh, teenager! You know, that kind of. But they can, they’re challenging. They’re different. They are weird creatures.

Weijia: Different is a way–

Dr. Patil: I have one at home right now so living through it.

Weijia: I’m praying for you.

Dr. Patil: No, she’s a good kid, but you know a teenager is teenager. Hormones all over the place, that’s a teenager.

Weijia: And they eat so much!

Dr. Patil: That too, haha.

Manasa: Umm so we’ll shift the gears a little bit as well towards your concept of future and things that you want to see you change in health care specifically. So, one of the big questions we have for you is, what are you working towards in your career? But you’ve come a long way already. But if you have a five-year plan or 10-year plan, or like the big things for the rest of your career that you wanna achieve. 

Dr. Patil: Yeah. It’s. It’s a very broad question at this time of the, at this time that age that we are living in right now is constantly changing. So I cannot predict five years from now what I feel now will be the same thing, because I think COVID has changed everything. What I mean by that is, COVID has changed the way we have to think about stuff. What is true today is not true tomorrow, right? So with that in mind, I would still say that what I want to change, the health care to go towards, is to become more patient-centric, to have more, could like, it should be a team effort. It should not be just a doctor telling them what to do. It should be a collaborative patient centered medical home kind of a concept. Patients are in board as well as the doctor, other ancillary people support staff that we need for them, resources, community, right? It should be like patient centric, so should be like a medical mode for the patient. So, because there’s so many social determinants of health right now that play in a patient’s life, it’s not just hypertension – give them hypertension medications. Right? Okay, it’s hypertension. Why are you having hypertension? Is it because of your diet? Is it because of your stress? Is it because of your job? Okay? You have hypertension – do you have the resources to get your medications? Do you have insurance? Do you have transportation to get to hospital if you’re in any kind of emergency? Alright. Do you have support? Do you have the education and the resources to decrease your weight, if that is what is causing your hypertension? So what I meant to say for that example is, if there’s a lot of things that plays into a patient’s life which can impact their health. So, a completely utopian world would be-Yes, we have all the resources to give for this patient to feel good that they can get to that place. Alright. So that’s what I’m hoping for. Health care move it. And I think health care is moving towards that, but I just said, COVID changed everything. We have a serious work force shortage everywhere. So how do you develop that resources and workforce? And when the patient leaves your office, you know that what you have done for them is not just given medication, but helped that patient not come back again with a serious problem, right? Are you having that impact on a patient’s life? And for that it means a team effort, a collaborative effort. And that’s where I want medicine to go to. 

Weijia: What do you think are  maybe some major obstacles that’s hindering the medical system from becoming, you know, more holistic?

Dr. Patil: It’s a lot of the inequities that we see in our population. Some are able to get the resource, someone not able to get the resources. The education background. The environment that they are living in. The information that they’re exposed to. But they don’t have the knowledge to analyze it and use it, right. Social media is everywhere now, and so it is. That is, a major obstacle that there is so much information out there. But you don’t, everybody doesn’t know how to use it, and there’s a lot, because of that, there’s a lot of inequities that we have to face. And because of those inequities, everybody cannot get to the same outcome that they deserve. Or we want them to have. So that is one of the biggest barriers, for sure. Information explosion without, how should I say this. Without the right education to analyze it, and what is good out of it. 

I don’t know if that answered your question. 

Weijia: Oh, yes, it did.

Manasa: Okay, so one of the things that we learn about in POM as well related to pediatrics specifically, are ACEs and how kids exposed to all these different life circumstances can lead to effects later on in their lives. So I guess working in pediatrics, specifically, so many social issues do play a role into how children are raised. And when I was doing my pediatrics rotation, one of the most difficult things for me to see is, like you were saying, if you don’t agree with a patient’s parents, and how they’re maybe interacting with the child. Or whenever you see them growing up through their different visits, knowing that there might be something that needs to change. But that you cannot force them to change. So I guess, how do you reconcile that as a pediatrician that wants to do what’s best for the patients, but also knowing that you have to give autonomy to the parents that are—

Dr. Patil: You have to always give autonomy to the parents because parents live with the patient, parents know them better than you do, because they are there. But at the same time, that’s where communication skills come into play, right? How well do you communicate with the parent that we both, as a team, can help your child. We both have to be on the same page. As much as I want to help your child, if I don’t see you want to help your child, then we’re not going to get anywhere. So to maximize the potential of success for this child, we have to meet halfway, you know. So it is very challenging sometimes, because again, I go back to level of education. Our parents are not very well educated, right? Their level of education is, and that is, this is like national, that the level of education of our patients, adult patients or parents, is at the fifth grade level. Okay, that is kind of the average. So how do you reason with a fifth grade knowledge, right? That is very difficult. So to answer your question. It is challenging sometimes. Sometimes, we are helpless. We cannot do anything because parents are not meeting us halfway there, right. And at those times, if we know the patient is in danger, we will have to make a DHS report. We’ll have to take the patient away from the parent which is the last thing we want to do. But yes, if he had, has to go to that level, we had to do it. But most of the time, if you sit down, talk to them and reason with them, I think they’ll meet you halfway. Again, what are their preferences? What are their values? I’ve read the textbook, so I know what to do, but if you’re standing there and trying to preach – “this is what I’m going to do, this is what I’m going to do, this is what I’m going to”- the parents are not listening to you because they are not involved in a shared decision-making. It’s not a shared decision-making, so always remembering that it should be a shared decision, trying to meet halfway, figuring out what their beliefs are, what their values are, is very important. Most of the time, you will be successful. But there’ll be many times when you have to have to be helpless. And do the last ditch effort of trying to save that patient. 

It’s difficult. Those are the times I go home, I go home many days feeling helpless. Yeah, if I win a Powerbowl, you know, the powerbowl. I would take all that money and make a house, or make a something to keep all these kids in that. Yeah. Because that’s where we are lagging. I want to take all these kids home with me, to take care of them, but not possible. 

Weijia: Unfortunately. Alright, as we’re getting ready to wrap up. Is there anything else that you would like our listeners to know that we haven’t covered yet?

Dr. Patil: Let’s see. I think we covered most. I mean you tell me if we have not covered anything but… anybody who wants to do pediatrics, it’s a great field, it’s a wonderful field, and we are all here to help. Talk to any of us. I’m sure any faculty here in peds will be able to talk to anybody who’s interested and help them, and figure it out with them. So just contact us and you’re good to go! 

Manasa: And then, if students want to contact you specifically to ask questions or shadow, or have you as a mentor, how can they reach out to you? 

Dr. Patil: I’m there on the global email list. So they can contact me, or they can reach out to General Pediatrics office, and they know how to get in touch with me, and I I can help. I’ve had lots of advisees in the past who have all matched in pediatrics. So I had three advisees last year, and all of them matched into pediatrics, so I was very excited for them. So I’m here to help, anytime, any way I can. 

Weijia: Alright. Well, thank you so much, Dr. Patil, for giving us your time and talking and sharing your life with us. And thank you for willing to be a mentor for our students.

 Dr. Patil: 100%. I love to be help students with their Aha! moment that they have. You know. Like when I teach or when I see that, is that aha moment is the greatest reward for me, and I’ve invested in everybody’s success. So call me anytime. I’m happy to help. 

All: Thank you!

Weijia: And if listeners, if you have any questions or comments or concerns, please reach out to us and let us know.

Introduction

In this episode, learn about Dr. Nolan Bruce, a trauma surgeon and intensivist here at UAMS. We discuss his career and research interests, as well as his take on different aspects of a medical education/career. We also discuss some of his interests outside of medicine, including sand volleyball, and his pets!

Listen to Episode 6

Transcript

Weijia: Welcome to the next episode of Mentor Spotlight, your very own UAMS student led  podcast to help connect students to faculty mentors. We are Weija, Hannah, and Manasa, your hosts for this episode. Today we have Doctor Nolan Bruce, another great surgeon in the Division of Trauma and Surgical Critical Care. 

Manasa: Doctor Bruce received his M.D. from the University of Oklahoma, then finished his general surgery residency here at UAMS and then made a stop at UT Southwestern to complete a fellowship in surgical critical care before returning to become a faculty member. He has been a part of numerous work groups and committees to improve care for patients, including the ECMO program here, as well as initiatives to improve ICU outcomes, such as improvements for vent cleaning as well as pressure wound care. 

Hannah: He also volunteers to be a mentor to students during the surgery rotation in our M3 year. If you get a chance to work with him on the floor, and in the OR, count yourself as lucky, because he’ll make sure that you learn at least one new piece of information every day, that you’ll get to actively participate, and that you get positive feedback when you do something right. Which, let’s be real, can be one of the biggest pick-me-ups when you’re stressed out during rotations. We’re very excited to have you all meet him, so let’s get started. 

Hannah: Hi Doctor Bruce, if you could just start off by telling us a little bit about yourself. 

Dr. Bruce: Sure. Hello, my name is Nolan Bruce. I’m one of the trauma surgeons here at UAMS. I am an Oklahoma boy, born and bred. Came out here for residency and fell in love and haven’t left since really. Other than as they mentioned, a brief stop in Dallas, TX. I’m a rather private person. I’m a simple guy. I’m married. I don’t have any kids. I have some dogs, but I live a relatively quiet life and just outside of Little Rock, so there’s not a whole lot to tell about myself. 

Manasa: So, you’re a trauma surgeon, but you also hold a few other positions. So can you tell us a little bit about all the job titles that you hold and what you do for them?

Dr. Bruce: Yeah, I think one of the more interesting parts about my job is really, no day is the same. We have a lot of different hats that we wear amongst our group. So I would have to say that trauma surgery is probably one of my favorite parts of my job, but it’s certainly only a small percentage of it. So my partners and myself split duties caring for trauma patients as we’ve already talked about. Emergency general surgery patients. We also do the surgical critical care for the hospital. And then we have, because it’s kind of a 24 hour day business, we also have a night shift rotation where we cover all of those things at night, so everybody else can go home and get some rest. And then in addition to that, we also are the ECMO team here. So we are responsible for putting patients on and taking patients off of ECMO as well as caring for them in the ICU. So it leads to a lot of variability in your day-to-day practice because you kind of never know what’s going to roll through the door or what surgeries [you] are going to be doing that day or what’s going to be happening until you get here, to be honest with you. 

Weijia: That’s pretty cool. So how did you end up picking this specialty? 

Dr. Bruce: There’s a lot of reasons. Being introspective about it, I would have to say that it’s actually where my mentorship came from. I would say that the personalities that taught me surgery, most of them, were actually trauma surgeons. And I kind of, for lack of a better word, vibe with them the best. And a lot of those people are still my same mentors, like Doctor Robertson, and many of the surgeons here. And then there were some, some aspects that appealed to it. I enjoyed the shift work lifestyle. I like that there’s, you know, if I’m not in the hospital, one of my partners is in the hospital to care for him. And I think that our patients get good care that way. I don’t have to worry about going home and still answering phone calls and worrying about them. I know I can go home with the peace of mind saying that one of my partners is there to kind of deal with any issues that come up. So I enjoy the kind of shift work lifestyle in that sense. I also like that it keeps you on your toes. I think that you can become very passive in your kind of growth and learning if you just do the same thing every day. So I really appreciate, king of, the variability that it provides us. And then I think it’s really rewarding to take care of some of the sickest patients in the hospital. The critical care aspect of my job is honestly not something, at least academically, that I thought was the most interesting. But I’ve come to see that working with the patients and their families and you know successfully navigating through the sickest and worst times of their life is a really rewarding part. So there’s a lot of reasons, but those are the top. 

Hannah: So besides the clinical aspect of your job, you’re also in some ongoing research. Would you mind telling us a little bit about the research projects you’re currently involved in? 

Dr. Bruce: Yeah, so my biggest project I have going right now which is actually going to be finishing up this month is a multi-center trial sponsored by EAST, which is one of the national associations for trauma. Looking at using our trauma video review system to collect data and the specific project has to do with what kind of IV access is best, but the subtext of the whole idea is that it’s a fairly novel use of collecting data. Not many people are using video review as a chart extraction type method, so we have some ideas of how to use that going forward. And now that we’ve established, sort of this multicenter collaborative of system, trauma systems, that use video review, we have an opportunity to study a lot of things from that. So I’m really excited kind of, about, the direction that that’s headed. That’s my main research interest at the moment. As far as other projects, I’m mostly interested in looking at trauma outcomes. We in our department do a lot of research towards that. So for anybody that’s interested, we always have projects that are kind of going in that direction as well. 

Manasa: So we’re going to switch gears a little bit towards your personality outside of medicine. And I know you said you’re a private person, so we’re sorry if these are a little intrusive.

Dr. Bruce: That’s alright.

Manasa: What are your passions outside of the field/like the hospital itself? 

Dr. Bruce: So yeah, well, when the weather is nice, I love to play sand volleyball. So if there’s any sand volleyball players out there that want to get schooled on the volleyball court, I’m always looking for people to play with. 

Hannah: I do not excel at volleyball, so that to me sounds like… a very interesting hobby. 

Dr. Bruce: It’s a lot of fun. When it’s not time for sand volleyball season, I generally am spending time with my wife and dogs at home. We, as I said, we keep a pretty quiet life.

Weijia: And surgery has the image of having a pretty bad work-life balance. So could you explain on that? Does your job maybe break the stereotype? 

Dr. Bruce: That is a… So depending on your practice, your work life balance is going to be different. There’s not a blanket statement on that. I will say that being junior faculty and at 100% clinical, I am on a heavy workload side of things. So I would say my work-life balance is probably not as favorable as a lot of other positions, to be quite honest with you. That being said, I have plenty of time out of the hospital. I just had five days off and took a nice little vacation and things. So I have plenty of time home with my wife and kids. Or sorry, with my wife and dogs, which are my fur kids I guess I should say. 

But there are going to be different specialties that are going to afford more time out of the hospital. They’re gonna afford more regular schedule that don’t involve a lot of nights and weekends like mine do. The fact of the matter is, trauma is 24/7. They’re going to be nights and weekends that you have to work. I do work quite a bit to be honest with you.

Hannah: I think that’s fair. There’s a specialty for everyone. 

Dr. Bruce: Yeah. 

Hannah: So kind of just shifting gears a little bit more towards a little abstract. Hopes, dreams, goals. What are some of your current goals? It can be both, professional, umm like personal, for the future, either long term or short term. 

Dr. Bruce: Sure. I have no plans to move. I plan on staying here and working through the professorship pathway here. As far as my professional interests, I love doing trauma surgery. I think that’s my focus. But I also have a pretty steady elective general surgery practice. I would really like to see us expand our practice in a more minimally invasive, and include some robotics in there. So personally I would really like to include more robotic hernia repairs and things into my practice. So that’s kind of on the list of professional growth that I would like. Academics are, you know, you always have to have some sort of research project going on in academics. So I have the expectation that every year I’m going to, when this project is wrapping up, I’ll start another one, you know? Keep that moving. Hopes and dreams. Like I said, I love where I’m at. I have no plans on moving. I want to stay through promotion and tenure here and work through that. 

Manasa: So kind of similar but a little bit more different is like what do you want to see change in healthcare itself or are there specific to your patients or just in general as well? 

Dr. Bruce: Oh my gosh. Now there is a question that has a bag of worms. So we could spend an hour talking about that, but to put it briefly, I don’t think that it takes somebody working in healthcare all their life to tell that our system is imperfect. One of the biggest things that I would love to see is just expanded access to care. I think we, whatever form that takes without… I don’t wanna get into any political beliefs here. But whatever form that that takes, I think if you can expand access to care and preventative care, that’s going to prevent a lot of my job, to be quite honest with you. And that’s going to lead to healthier patients and better outcomes. So expanded access to care I think needs to be our priority. 

Weijia: So going back a little, you said that you love it here at UAMS, right? And you’ve been to Oklahoma, then to Texas. I was wondering what is very special about UAMS? What makes you love it here compared to maybe another place?

Dr Bruce: Yeah. So as far as places go, locations. They’re just locations. You can have a beautiful beach outside or a bustling city outside your hospital, but it’s not really going to have much effect on the time you spend in the hospital. What really does have an effect is the people you work with. I have great partners. I love working with my partners. They keep life fun. We have great APRNs that I love working with on our trauma and EGS and SICU rotations that I honestly genuinely love going to work with those people every day. The residents are the best sort of learners you could imagine. Any teacher that has a set of students that they can work with that closely and is that vested in the subject that they’re learning about is going to be the best sort of students you could possibly ask for, right? And then they kind of keep me young too, you know. They keep me interested, usually make me laugh during the day and things like that. So those are all important aspects. So for me, what draws it here? It’s got to be the people and the work environment. I mean even the people in the office side, the people in the office here are lovely. Like everybody has a smile on their face. They’re generally nice people that wanna help out. Same for the folks in the hospital and that makes going through your job a lot easier, I think. 

Hannah: So you kind of touched on it in your last answer, or like, gave us a little bit of information about the qualities of the type of people who work in the surgery department, at the residency, your colleagues. What kind of qualities do you think you would look for in someone who wants to go into surgery or is interested in surgery, so they can base it and be like “maybe this is a good specialty for me, maybe this is not the best specialty for me.”

Dr. Bruce: Yeah. So as far as qualities that make a good resident, there’s probably no universal qualities, right? I think one of the things that makes residencies work is that everybody brings something a little bit different to the table. And that being said, the best that I can get to universal qualities that are going to be helpful is just a willingness to learn and continue growing. I call it coachability. People who, in general, have learned to work with a team through whatever method they have got there. A lot of times that requires team sports or music or things like that. That they’ve learned how to take instruction and continue to develop. And I’ll take that construction as criticism or personally and things like that. So I think what I call coachability is probably one of the number one things that I look for. Number 2 is you do have to have some degree of emotional maturity when you’re going through surgical residency. So that’s harder to gauge just on interviews and things like that. So we look for work experience, life lessons, things like that, that may have taught some sort of emotional maturity and how to handle bad situations. How to handle failures and things like that. Those are where you sometimes see people kind of make or break. So I think as far as universal qualities, those are some of the best qualities that I look for.

Manasa: So if you could give one piece of advice to medical students, either interested in surgery or not, in general, what would it be? 

Dr. Bruce: Just be open minded going into everything. For you M1s  that are kind of starting things out, you should go into every rotation and every subject thinking that maybe this is my favorite subject, you know, and at least give it a shot. You’re A., going to learn more if you’re interested in it and you genuinely tell yourself you’re interested in it. And #2, the people that are teaching you are going to be more motivated to teach you more, and more invested if you’re invested in it as well. So yeah, just be invested in every subject that you kind of go through, whether it’s surgery or not, even though obviously it’s going to be surgery. 

Weijia: And what’s the best advice you’ve gotten? 

Dr. Bruce: Advice is only worth about what you pay for it, to be honest with you. So here I am giving you advice and you’re not paying me anything for it. But if you’re looking up these podcasts, I guess by definition you have some investment and you’re kind of paying your time for it. So what I mean by that is, advice that falls on deaf ears is not useful advice, whatever. So that’s a hard answer for me to answer as a blanket statement, but the best advice I’ve gotten has been timely advice when I needed it through my life from mentors. So I don’t know that I can pass along a single specific word of advice, to be honest with you, other than what I’ve already given. 

Hannah: Ok. So changing gears just a little, what is like the coolest or the most interesting, unique, one of your stand out, just in your mind, always goes to it, surgery that you have done to date. If you can talk about it.

Dr. Bruce: Yeah yeah, no problem. So I’m sorry, the question is basically, what is my favorite operation? Is that what you’re asking? 

Hannah: Yes, or just one that stands out in your mind.

Dr. Bruce: Okay, we can edit that part out by the way if… [everyone laughs]… cut out some of the repetitive parts.. we will fix it in post. Ummm no. So one of my favorite operations, and honestly like what I’ve already told you guys, I love trauma surgery. You take somebody that’s got a penetrating abdominal injury, and that’s always a good day for me. It’s a bad day for somebody obviously, usually one of the worst days of their life, but that’s an enjoyable process for me. You take somebody that’s in an extremis and the bad, you know, the worst situation possible, and you’ve got an opportunity to very immediately go in and fix what’s wrong with them. And there’s very few things in medicine that I found that is as gratifying as that. So yeah, I would have to say good old exploratory laparotomy for trauma is one of my favorites. 

Manasa: Is there any specific case that you’ve done that you can remember that’s your favorite or just like in general any kind of ex lap…

Dr. Bruce: Well, yeah, I don’t want to give any specifics or anything like that. So no, we have some standout cases but not, not for discussion. 

Manasa: No worries. So if a student wants to contact you, if they wish to have you as a mentor, ask a question, or just shadow you whenever, what’s the best way? 

Dr. Bruce: Yeah with. Again, I am not going to broadcast all of my public information on whatever this is going to be posted. The best way to contact me is just through the UAMS directory and my e-mail. So for any UAMS students you can very easily just search my name, Nolan Bruce, and my e-mail will be right there. So send me an e-mail. That’s the best way to contact me.

Hannah: Is there anything that we haven’t covered today in the podcast that you would like us to know? Either like, just general advice, any topics you want to talk about, anything you’re really proud of? 

Dr. Bruce: No, unless you guys want to talk about some volleyball or something. 

Hannah: Right. I’m afraid I don’t know enough about volleyball…

Dr. Bruce: Favorite restaurants or anything… No, no I don’t think I have a whole lot to add. I enjoy working with, you know, the primary target of this is going to be medical students, I assume. I very much enjoy working with the medical students. I’m always open to new ideas that they may have or if they just want advice. I’m generally happy to help with my time with whatever I can. So while I’ve already prefaced this with saying I’m a private person, feel free to approach me. I’m happy to talk to you about it, okay. 

Weijia: So I have something for you. This whole interview, I’ve been staring at this painting. For our listeners, Doctor Bruce has a painting of a dog in a general suit. And it’s very large. It’s right next to his computer. I think that says a lot about his personality, too.

Hannah: I think it’s a German shepherd, for those of you who are wanting to picture a specific dog, yes.

Dr. Bruce: And it’s got like a kind of a spotlight on it too, so you can’t miss it. So yeah, there’s like diplomas and all sorts of other things. But that’s the, that’s the position of prominence really.

Weijia: And I was wondering if you could expand on that picture. Is there a reason? 

Dr. Bruce: Do you need more explanation other than it’s my dog and in some sort of like old-timey general outfit? I don’t know.

Hannah: Was this a commissioned piece?

Dr. Bruce: I don’t- I honestly don’t know where my wife got that from- but I’m sure it was somewhere she found online that photoshops dogs’ heads onto old-timey general outfits.

Hannah: I guess the role of this story is, you get to know a lot about your attendings based off what they’re office decor is. 

Dr. Bruce: Yeah, very true. 

Manasa: Alright, well thank you for taking time out of your busy schedule to be part of this podcast Doctor Bruce. 

Dr. Bruce: Absolutely. I’m honored that you guys considered me to be interviewed for this. So thank you. 

Manasa: Very excited for all the students to meet you. And listeners, feel free to reach out to us if you let us know your thoughts, concerns, questions, anything that you have to say, and see y’all on the next episode!

Introduction

Dr. Kathryn Stambough is a pediatric and adolescent gynecologist at ACH as well as the Assistant Director of the OB/GYN Residency Program at UAMS. She provides care through the General Gynecology Clinic, Differences of Sex Development/Differentiation Clinic, Spinal Cord Disorder Clinic, as well as the Gender Clinic. She is passionate about reproductive health care and is an excellent mentor and teacher to students. In this episode, we discuss her journey to this subspecialty within OB/GYN as well as her goals for the care she provides as well as for Arkansas. She shares her advice for medical students, the impact a mentor had on her journey, the importance of advocacy as a physician, the realities of “balancing” work and life, plus much more.

Listen to Episode Five

Transcript

Manasa: Welcome back to Mentor Spotlight, the podcast to help UAMS medical students connect with faculty mentors. This is Manasa, and today I’m excited to have a conversation with Dr. Kathryn Stambough, pediatric and adolescent gynecologist in the Department of Obstetrics and Gynecology. She’s a Fellow of the American College of Obstetricians and Gynecologists, and the North American Society for Pediatric and Adolescent Gynecology, as well as a steering member for the latter’s fellows research consortium. While originally from Little Rock Dr. Stambough completed the majority of her medical education in Missouri at WashU, and Texas at Baylor. She’s returned to be a part of the team at ACH, and if you rotate with her you will see that she loves to teach. She is actually the first preceptor that I worked with during my M3 rotations, and I had a great experience with her getting dipped into the sea of medicine that we see in M3 year. So I’m very excited, for you all to meet, and let’s go ahead and talk with Dr. Stambough! So first off, we’ll start off with her telling us a little bit about herself. So I’ll let her introduce herself to y’all!

Dr. Stambough: So thank you, I can’t believe it’s been that long since we met each other, so gosh time flies right? This is crazy so…  I’m Kate Stambough, I’m originally, from Little Rock, like you mentioned, born and raised, left after high school for college. And then kind of stayed in St. Louis where I did college for medical training, and worked a little bit before going back to fellowship in Texas.

Manasa: Ok, yeah. So I guess if we had to look at your whole career at Children’s here so far, plus before whenever you worked before you went back to fellowship, that then after as well, what has your journey been like since there to here?

Dr. Stambough: My journey has been an eventful and fun one for sure. I think when I started out thinking about wanting to be in the medical career, I think as a field we are all used to that stepwise fashion. Right. We go to college, we go to medical school, we do residency. And then Laser focused on potentially, you know, kind of getting out and into the role of practicing medicine or kind of going on to fellowship to do more specialized training. I think, along the way, I always knew that I wanted to do fellowship, but from me, there are things that came up kind of in personal life and creating that work like balance that meant that that my route was a little bit more circuitous, right, that I that I worked before kind of coming back to more specialized training, and then in terms of knowing that I was focused on a goal, but also allowing myself to make sure that outside of work, those places that were important also kind of got met as well, and so eventful in that I have been able to build interests in life outside of medicine, and then also reach those goals, eventually finishing fellowship and then being able to specialize in what I do and love now. 

Manasa: Yeah, that’s awesome. I’m glad you were able to find the path that fit you right. 

Dr. Stambough: Absolutely

Manasa:  If we had to talk about all the job titles that you have currently, what would you say they are, and describe their roles.

Dr. Stambough:  So absolutely. I think my official job title is Assistant Professor in Obstetrics and Gynecology, and that I mainly work under the Division of Pediatric and Adolescent Gynecology, which is where we met in terms of a majority of my clinical practice team being over here at Children’s. When I’m over here at Children’s, I primarily practice in the General Gynecology Clinic taking care of reproductive needs for patients up to age 21. But I also hold a couple of other hats in some multidisciplinary spaces which are super exciting for me. So I help provide for patients on our Differences of Sex Development or Differentiation Clinic. DSD is kind of the common term you guys probably come across as you learn about that in your M1 and M2 years, and that’s a super fun clinic with a great group of people. I care for patients in our Spinal Cord Disorder Clinic, as well, and then in our Gender Clinic. So I do that both here as the medical director at AR Children’s, and then also on the adult side as one of the physician members of the team in the Adult Gender Clinic at UAMS. 

Manasa: Okay, that’s awesome. We’ll get more into that a little bit further into the interview as well! So if a student came to you asked you what’s your typical week is like, or what might I expect my life to be like if this is the career path I picked, what would you tell them?

Dr. Stambough: Absolutely. I would tell them that it kind of changes day to day and and really week to week, and I think that is part of the reason I love what I do. Certainly, I am in clinic a lot, and a lot of our practice in our cure is delivered in a clinical setting. I have kind of the excitement of going to be the OR throughout the week, and then doing some really fun administrative tasks as well. So usually week to week, about four days of clinic and that’s balanced between general gynecology and then some of the other multidisciplinary clinics that we discussed, primarily with the bulk of that time being with gender patients. And then one day a week, I’m in the operation room, which is super fun to do! And then along the way, there is going to be some fun meetings, and then kind of most recently have transitioned into the role of Assistant Residency Director for Obstetrics and Gynecology, so spend at least a half if not a full day a week doing some administrative tasks. And then focusing on resident didactics and learning. And then along the way, there’s call and anything that comes in as well with that! So it’s fun and exciting and no two days are the same, which is which is great, which I love.

Manasa: Yeah, that’s awesome. So let’s shift a little bit to your educational background that you had. So you left Arkansas to get an education, in Missouri, and then Texas. Can tell us a little bit more about the process of what made you pick the programs that you did?

Dr. Stambough: Absolutely. So you know, I’m born and raised in Little Rock, and don’t get me wrong, obviously love my education here, but knew that I kind of wanted to get out, always knowing on the back end of that, that my goal was to make it back to Arkansas, both to be closer to my family and my friends, but also to provide care for patients in Arkansas. So that was always my motivation. St. Louis- back to my 18 year old self was kind of far enough away to where I got out of Arkansas but close enough that I could both drive and fly if I needed to get back home. And St. Louis was a really cool town to go to college in and I fell in love with it, which is why I stayed in terms of medical training, and then residency. It’s got a really robust system for health care training and I had a great time and absolutely loved my experience there. And I stayed on for a few years, and worked because I ended up meeting my husband there and starting a family. So that’s kind of where that circuitous route came up, and then ultimately always knew I wanted to go back to do a fellowship in pediatric and adolescent gynecology and so was super fortunate to be able to head to Houston to do that. Houston’s a great town. It’s a super fun place with a bunch of amazing medical institutions. And so it was really a great collegial place to train. And for kind of that focused specialized training. But again, always with that kind of goal on the back end of making it back here with a little bit of extra experience and a little bit of a different flavor in terms of training other places to bring back to UAMS and to Children’s.

Manasa: Yeah, that’s awesome! I guess since you are also in one of the program director roles for the residency program, since so many students are interested in going into OB/GYN, what would you say should be the factors that students should look into when considering a program when they are applying?

Dr. Stambough: It’s a great question, and obviously kind of front of mind at the moment since we are here. You know, I think that there are a few things, I think you know there’s the most obvious which is making sure that you’re looking at a program that would kind of fit what your interests are, and it’s always a hard question, right? It’s the question that we always ask and would you want to be a generalist? Do you want to do fellowship or some specialized training… that’s a hard question to answer when you haven’t even started. Right, because we ask you what you want to do based on maybe a four week rotation and then some sort of AI. And so I think if you were not certain, then making sure that wherever you’re going has kind of a balance approach to being able to train you and that people, it seems like historically, have come out of there both being able to be a generalist as well as fellowship training. I think if you know exactly what you want to do, making sure that that program can meet those needs or that you have interest at that program that program can meet those needs. And I think there are things that we don’t talk about much about right? So making sure that wherever you are interested has some work life balance, and some things that outside of work that are going to make you happy and make you whole. We’re so used to being so laser focused on kind of the work that we do and the training that we do. But I think we have to always pull back and be really honest about whether that place and that space in that city can kind of meet those needs and those interests that you have outside of the hospital. I always think the meet and greet with the residents is really important. Do they like each other? Does it seem like a family that you would be joining that would be there for you for the duration of your residency? And I think all of those things outside of rotations and outside of services that they have that would interest you, right, whether it’s leadership, whether it’s research, whether it’s being able to get involved in the community that you kind of value those and then make those a factor in your decision too.

Manasa: Yeah. Do you have any specific tips for getting a feel for that environment on a Zoom call?

Dr. Stambough: Oh sure! I know right the landscape has totally changed, in terms of not being able to be there physically in person, and really to see the dynamics. And not just, you know, I feel like we always have to have a little bit of an asterisk, right, when we do it to know that Zoom calls are so awkward and doing a happy hour where it kind of looks like the Brady Brunch on the screen and kind of that awkwardness of who’s going to talk and cutting each other off and missing those kind of social cues that we can read better in person can make it hard. But I do think as much as you can, paying attention to what the residents say. Right? Do they seem happy? Do they seem like they get along? Kind of ask them about their life outside of the hospital right. Ask them about their experience, and then being, you know, being able to ask honest questions from the faculty and the staff that you meet with, and not being afraid about kind of asking about things that are important to you. I always want to make sure that the interview–it’s a two-way street, right, so we want to make sure you’re a great fit for our residency program, but at the same time, you have to make sure that we’re a great fit for you. And I think that that framing the interviews in that, right, instead of kind of just showing up and feeling like you’re on the spotlight but remember that the program is also in the spotlight. So we want to be open and honest, and really transparent about the things that we think we can meet that are your goals, right. And then always tell you, if you have an interest that we think, Gosh, it may be better that you went somewhere else. In terms of making sure that you get he best training that you possibly can. But I think paying attention to those kind of interactions on a personal level among the residents, and then kind of the faculty, you know and feeling freedom to ask those questions that you think are important to you.

Manasa: Yeah, that makes sense. Like you were saying, it’s a two-way street so you gotta make sure you are a good fit from both sides. 

Dr. Stambough: Absolutely.

Manasa: Yeah. So, we kind of took a detour there, but I guess if we went back to you deciding you wanting to pursue Obstetrics and Gynecology back in medical school, how did you make that decision, and what attracted you to OB/GYN specifically? And then also pediatrics and adolescent gynecology?

Dr. Stambough: Absolutely, I have a background in terms of degrees in biology and psychology, and I’ve always loved and kind of that aspect of growth that that we go through as teenagers, right, in terms of kind of how our frontal lobe develops, and how we kind of end up being the person we are. And so I thought I came into medical school thinking I wanted to do adolescent medicine, actually. I loved the aspect of kind of taking care of patients, and what I felt like was a really important part of their lives, and essentially having that impact to kind of shape where they went. And when I was in medical school, I had the good fortune between my first and second year to run into a pediatric and adolescent gynecologist who just happened to reply to an email when I reached out about doing research, and from there became such an amazing mentor. Who I still talk to, and I still call when I have questions. And she was great because she went into the field when there was nobody doing it, right, so kind of created the field and is one of the founders of the Society that I’m a member of, and so she was just such an important part of helping me realize that this was something that I loved. I did research in it all four years of medical school, and then I really remember when I did rotations that M3 year, which seems like forever ago to think about now, but the way we did it was our pediatric and our OB/GYN rotations were sandwiched right next to each other. And so it was really nice to be able to do those back to back and realize that I had much more interest in the obstetric part of kind of care than in the pediatric part. And that there was this field, though, that still kind of let me hold on to what I thought I wanted to do in pediatrics in the beginning which was taking care of teenagers. I just love reproductive health, actually I feel very passionate about it, and I love procedures. I love being in the operating room, but I also love being in that clinical space of being able to have relationship with patients that you can carry over time. And so for me, OB/GYN felt like the best fit after kind of coming in with that interest, and then doing those rotations and kind of where I ended up.

Manasa: Yeah, it’s amazing how one person that you never knew, could like change your whole track. And I mean, you kind of had an idea I guess of kind of what you wanted to do. But they become such an important part of your story.

Dr. Stambough: Absolutely, mentors are important for sure.

Manasa: Yeah, and I am very glad you agreed to be a mentor for our students.

Dr. Stambough: Yeah, absolutely! Absolutely!

Manasa: So if you had to describe about your passions for the field itself. I know we kind of mentioned some of the aspects of the clinical work that you do, and the interests that you came in with when you started residency. Or is there anything else that we haven’t talked about or that you can describe in more details such as the research that you’re doing, the Gender Clinic and the DSD Clinics you are involved with?

Dr. Stambough: Absolutely, I think you know my main passion is just reproductive care. Within the last year, we’ve had some exciting, kind of opportunities to start to engage the community and filling in gaps that I think we all probably feel and know exist, right, you know when we think about our education system, there’s not a lot that’s mandated in a way that our kids and teens learn about themselves, about their body, about healthy relationships, and about growing up. And on the flip side of that, there is some outcomes that we could probably improve. And so in the last year we started doing a curriculum for the community called Girlology. It’s super fun, it’s exciting. We get parents and kids ages 8 to 13 to come in. We lead the discussion, which I think takes a lot of pressure off the parents. And also a lot of anxiety off the kids in terms of having that, you know, really awkward kitchen table talk about like puberty and changing bodies and healthy relationships. And making smart decisions for yourself as you get older. And then my hope is always that then leads to a transition that feels a lot less intimidating for patients, and for their parents and guardians to keep that conversation going at home when they know that we’ve kind of started it. So I think I’m really passionate about reproductive care, both in terms of engaging the community and still building hopefully some opportunities for Arkansas in general to fill in those gaps. but also in how I deliver care in the clinic. I love that I get to do visits with a patient and generally with a parent or somebody that comes with them. I think that that dynamic is exciting and challenging, and my hope is that we can fill in some of those gaps and break down some of those barriers that I think parents and patients feel that they’re home trying to have these conversations. And then, you know, a lot of my research and a lot of my passion surrounds provision of care for transgender and gender diverse patients. Obviously it’s a population that deserves the dignity of the same level of care of any other patient, but certainly has had challenges when it comes to kind of getting care, and so I love that group of patients, I love the care that we deliver, and I love how to figure out how to advance that care so that we’re meeting their needs.

Manasa: Yeah, that’s awesome. Yeah, I think, as a field, OB/GYN has been in the media recently, for many reasons. Especially in Arkansas, as well, as over the past few years. So how has your field been affected? By… I know it’s hard to have a political discussion where we bring in concepts like that into the daily care that you provide. But you also have values that you want to uphold. And then, as a field, as a physician, you want to be the best provider for the health of individuals, especially as you said, adolescents that are growing up and finding their own identities.

Dr. Stambough: I think it’s hard, right. So in medical school, we’re taught kind of evidence-based approaches to how we care for patients, and then we go through residency and those get hammered home, and we develop and refine our skills, and then to come out in practice…The expectation is that we would be able to do those without limit. Right? And that we are respected among our peers, that we continue to review the literature, and we continue to have some ongoing medical education, and that there are not going to be barriers besides the ones that we create from new research and new recommendations, and expert opinion on the care we provide, obviously knowing that our fields are always changing… and so to bring politics into that can often be challenging and knowing that there are people who haven’t done the specialized training that you’ve done, or to have kind of misconceptions about the care you provide that create limits on what you think is best practice. It’s always hard, right? The ethics of that become hard, the morals of that become difficult. I think the most important thing is that you always show up to provide the best care for the patient, and that you have open and honest conversations with the patient about kind of if there’s legal challenges or legal limitations to the care you otherwise would be providing, that you find a way to get the patient the care they need. Obviously, you know no, you know, breaking any laws or doing anything like that. But you know patients deserve to kind of know this is the evidence. This is why we can’t do it, right, and then to make the best decision for them. You know, I think the other thing that we don’t really learn that much about in medical school, or at least I didn’t, was like advocacy, right? Like that’s not a hat that many of us ever really put on because we’re busy. We have so many other things going on. But it certainly is an an OB/GYN and reproductive care provider, something that I try to kind of lead into and step up to, is really you’re the expert, right? And it’s ok to say that. Sometimes, I think that we’re super humble, and we don’t want to say we’re the expert in something, and we just want to do our work and take the best care of patients we can. But in these space where you may find that others are being very vocal about something that you do but acknowledging that they do not have the foundation of knowledge or the experience that you do, it’s okay to step out and say “I’m the expert in this, and to really provide a balanced kind of view. You know, I think people often don’t know what they don’t know, right, and that’s where kind of dangerous decisions and dangerous dialogue comes from. And so it’s really one of those things where over time, I’ve had to be more comfortable in entering the dialogue, even though that’s not at all something that I was trained to do and not at all something I think we generally feel comfortable doing. And in joining the dialogue, hopefully, you can create some more balance and some more perspective. So that we can kind of shift the tide and help make more evidence-based decisions for our patients without kind of political pressure or political limitations.

Manasa: Yeah, I’ve heard the saying like “Silence can mean compliance at times,” so as someone in power as a physician that’s has the education like you’re saying, it is important for advocacy for patients.

Dr. Stambough: Absolutely. And it’s intimidating. I mean none of us are used to getting up in front of a panel, right, and getting asked questions by people who aren’t physicians, and it, you know, it could be intimidating. And it was something that I was wholly unprepared for when I first started. But you become more comfortable with it, and in the back of my mind, I just remind myself that there’s a whole bunch of patients behind me who don’t have the same opportunity for our voice. And so I think that’s always whenever I get uncomfortable or nervous, or uncertain, what I try to hold onto. But it’s okay to own the fact that you’re talented in what you do, and that you’re an expert in what you do, and to try to bring that balance and fill that kind of silence which I think is otherwise taken for saying, “Okay fine.” Right, but it’s not fine, I think we all kind of go into what we go into to provide the best care for patients possible, guided by evidence in our experience. And so when those clash with kind of what limitations are put outside of that, I think it’s where we have to step up and explain why we think that’s not the best decision for our patients.

Manasa: Yeah, that’s awesome. So we’re gonna shift gears a little bit towards your personality outside of medicine. What are you passionate about, in terms of the things that you do outside?

Dr. Stambough: Oh, sure, yeah! So, I have two kids. Well, I have three kids. I guess I should say. So, I have two boys, five and seven. That are my biological kids, and then my husband and I are foster parents, so we’re really passionate about the foster system. I think it’s something that being, right, being a pediatric gynecologist, we have a lot of contact with, and certainly have had years to kind of see the need for filling those gaps in terms of caring for kids and teens awaiting reunification with their parents, or care givers are kind of awaiting a family to take them in in kind of forever family. And so we have loved that experience. So when I say two, I mean three, cause we currently have a foster placement who is adorable. And just turned three and has been amazing. So that is something that we’re passionate about and that fills a lot of my time outside of work. My boys are busy so it’s a lot of going to soccer practices and doing stuff at school. And I try to be as involved in their school as possible. So I’m on the PTA and I plan their field day once a year which is super exciting. So filling in those places and showing up where I can for them is kind of what fills most of my time outside of work. But I like to exercise so I do indoor cycling–it’s like how I keep myself sane and how, you know, when those moments feel hard, I’m able to just go into a dark room with some loud music and kind of forget about everything for 45 min. So those are generally what keep me busy outside of work.

Manasa: Yeah, what are your most favorite artists? Or songs?

Dr. Stambough: Oh, gosh! I don’t know. I mean I kind of listen to all sorts of music. Yeah, I mean, anything. 

Manasa: Do you have an OR playlist that? 

Dr. Stambough: Oh, gosh! Yeah, sometimes I do, yeah sometimes I do yeah. Sometimes I listen to, umm like a lot of 90s music, which I’m now dating myself. But I do listen to a lot of that, but generally I just kind of put some spotify channel on random, and see what happens, there’s not a lot of music that I don’t like, to be honest.

Manasa: Just go with the flow.

Dr. Stambough: Just go with the flow, yeah! Yeah i’m trying to think about what I was listening to this morning… I have a chill Mix on my spotify which is what I generally listen to in the morning, might get more ramped up later in the day, but that where we start!

Manasa: Haha, yeah, that sounds good. I guess we’ve talked about this a little bit as well, but as like work-life, balance aspect of things, and then being a female surgeon. There are obviosuly challenges that we hear about throughout medicine where they tell you that it’s hard to have both. But then you also hear of people successful, like you, who are able to make it work. So what do you think are factors that females should consider, but also not put ourselves in a box to where we’re saying, “Oh, we always have to find this balance,” having the confidence to go for it and do things.

Dr. Stambough: Yeah, so I think I do not at all want to misrepresent where I am at, right. So I think there are things outside of work that I value, right. And I say yes to those. So, but I do that in a way that’s manageable. And so I think, first and foremost, becoming comfortable saying no is really important. It’s such a foreign concept to us in medicine, right. Somebody comes to you, and they ask you to write a case report. You immediately say, “yes!”, right? Somebody asks you if you can stay late and do something, right? And you immediately say, “yes!”, right? And so to do the opposite, which is just say “no” can feel really hard, because we are used to kind of climbing that ladder and getting to the next step and wanting to be, you know, fill our CV, and things like that. And so every time you say no, sometimes feels like a missed opportunity to do those things, or the person asking you is really important to you. Or the ask is really important to you, but the first and foremost it’s getting comfortable saying no, either when it isn’t important to you, you know where the value placed in that to you isn’t worth the ask. And that’s okay, right, like do not have to write every chapter somebody asks you. You do not have to write up every patient that somebody else feels is interesting. You don’t have to take on every research project that gets launched your way, and that’s okay. I also think outside of work that if there are things that don’t have value added for you, it’s ok to say no. It’s also okay to ask for help. So there’s a mountain of people behind me that help me, right, where I am. And I once had a mentor and I asked her the same thing. You seem like you have it all, right, like you are so prolific in research. You are an amazing surgeon, and a clinician, and yet you have kind of this family, and everything you do outside of that, and she said” Oh, I don’t do all those things.” There are things where I bring in help, because they’re not things that being me joy and they are not things that are value added for me. And then I really focus on the things that are, and so for me, I have help outside, right, in terms of caring for my kids. There’s somebody who helps get them to school in the morning. There is somebody who helps me in the afternoons and evenings if I need. And there are plenty of things that I don’t and am not able to do, right, so the field trips- I don’t make it to. There are all these things where we also have to appreciate that you know we can’t do it all. We can’t mentally do it all, we can’t physically be in all those spaces, to let go of the guilt that comes with that. Let go of the expectations that you can be kind of both this the surgeon and clinician that you want to be, right, but also the concept of a stay-at-home mom with everything that comes with that and meeting every single need. Like those two can’t co-exist, and that’s okay. So when I talk about doing field day, I do field day because it is the one day a year where I block my schedule and can show up, right. And so that to me is manageable, everything else I cannot do. So I can’t make it to every little class party, I cannot make it to every little after school event. That’s okay. But when I’m home, I’m present, and when I can, I carve out time to show up, and so that could be a hard balance to strike, and definitely I get wobbly sometimes in terms of trying to take on too much. But also every now and then coming back and doing a needs assessment, right. Where am I? What am I doing? What’s too much? What can I let go of? What do I want to do and can take on, and then being okay going back to things, too, saying no upfront, but also going back to things and saying I need to let go of this, because that can be really challenging once we get started and invested in something, to kind of do an assessment and figure out maybe that’s not something that we want to continue. And that’s totally okay. Totally okay, So that’s come over time. And also just to get people around you that you trust that can kind of help you like built a good team. But I think this idea of being able to do it all can feel pretty toxic and hard, right, because we create these, really really big goal posts for ourselves that are often impossible to meet. And sometimes, its not graceful, right. Sometimes it’s not pretty. Sometimes, I forget that like I was supposed to do X or Y. And that’s okay, too. You gotta have some grace with yourself and know that we’re all human. We’re all showing up and we’re all doing the best. But kind of that ability to say no, that ability to self-evaluate, and that ability to kind of let go when things aren’t where value’s added, I think the most important.

Manasa: Yeah, that great advice. So we’re gonna shift gears a little bit more as well. So if I was to ask you, what are your goals and future dreams, either in the next few years, or in the long term, within your career or personal life also?

Dr. Stambough: Absolutely. I think you know, just coming into the role of Assistant Program Director. So my goals are really to continue to further the education of residents in our program, and to get much more involved in terms of didactic training. And then helping make sure that our residents graduate feeling, which I think they do already, but feeling comfortable being generalists, but also making sure they are poised to go onto fellowships if that’s their goal. I think, from career goal, there’s so many more things I would love to do. You know, I think, building up our Gender Clinic is really important in terms of meeting the multi-pronged needs of our patients. And then I think there’s a lot more opportunity that we’re now able to kind of hopefully take and kind of meet in terms of community needs for reproductive health and filling in those gaps in Arkansas that I can’t wait to meet. We’ve got some really exciting things that we started to develop. And some really exciting curricula that I think will be able to roll out to hopefully help those needs. I think you know, ultimately I came back to Arkansas to be able to care for patients ,right. And there’s a lot of gaps in terms of care, and a lot of outcomes that I think we could improve in the state, and so you know, the bigger goals are obviously to move, to move those numbers in the direction that we want in terms of things like teen pregnancy, maternal and infant morbidity and mortality. And so hopefully, with doing some of these things, we can really make a difference.

Manasa: Yeah, ok sounds great! If you had to change something in health care or have a main concern about it right now, which we’ve covered a lot of topics already, what would you say one of your biggest concepts of the system is that you wish would change?

Dr. Stambough: Oh goodness. You know health care is such an interesting place to be right now, because the landscape has changed so much for me from even when I did training, right. So I think patients are getting their information from different places. A lot of it is on social platforms and there’s a lot of misinformation and a lot of misconceptions that can make it a little bit more difficult to practice now. I think more so than ever. I felt the pressures from politics and from legislators about impacts on our care that we never had before. And so I think those things can feel weighty and hard. I think where I would love for medicine to go is for us to become our vocal advocates for the care that we provide, and that’s not just reproductive health providers, right? That’s not just OB/GYNs but for every practitioner to feel, right, that when one of us feels challenged, or when one of us has the evidence-based care that we provide limited, that we all feel that, right, that we all feel called to kind of step up. I think your generation of trainees, more so than ever, is stepping into a role where you can be really big advocates and a lot more vocal about the care that you think you should be providing… like we’re not used to that. That’s not something that we ever felt like we had to do, and I mean certainly, I remember going to training and always thinking, well, there’s somebody else to do that, right. But I think regardless of if you go into OB/GYN or something else, you know, recognizing that as a field, that we begin to advocate for ourselves, that we begin to step up for each other and really support each other, knowing that there are these external pressures that are making the care we provide a little bit harder. I would love anytime that there’s something that affects OB/GYN for kind of everybody else to also come back and champion and say you know I think we just stand need to stand for physicians being able to practice medicine. Would be where I would love for the field to go. 

Manasa: Yeah. If you could give one advice to medical students today, what would it be?

Dr. Stambough: Have fun. I mean, I think it’s stressful right. It’s four years of stress. It’s four years of being in the classroom, particularly the first two years, having these didactics, and then you’re thrown into the wards, and it’s kind of just go go go, right, and it’s sometimes hard to step back and realize that what you’re doing is fun and what you’re doing is exciting, and what you’re doing is meeting these kind of goals that you’ve always had for yourself. And make sure that that fun is not only while you’re working, right, but outside of that too. It’s okay to take time for yourself. It’s okay to start to work on that work-life balance now, because that’s the foundation you want to set before you start to really get out in terms of residency and start to really get out in terms of practicing. I mean, just like anything, right, we need to practice first. And so practicing those periods of how having fun, both at work, and also outside of work now, are really important.

Manasa: Yeah. And then, if you have to say you had, like one great piece of advice that someone gave you throughout your journey till now, can you recall anything like that?

Dr. Stambough: Oh, gosh! I know in my mind they all kind of get melded into this kind of like feeling. You know the mentor I talked about earlier, who was the one who introduced me to the field that I’m in now, and really is just primarily responsible for my path. She used to just always say to pay attention to that feeling, like right, that feeling when you’re on a rotation, that feeling when you’re in a clinical setting of if it made you happy. Like I can distinctly remember seeing patients with her between my M1 and M2 year, and just walking out of a room like that was awesome, right, and it could have been the most mundane, straightforward office visit, but, like that was great. Like those moments are important to pay attention to, and they’re not always gonna feel like that. They’re gonna be days that no matter how much you love what you do, feel hard. But you want those days to be outweighed by the days that feel good. Right. Those days that feel like this is what I was called to do. And that’s okay- like it’s okay to say that. It sounds kind of cheesy, right? But really, that feeling of this brings me happiness. This brings me joy. This is something I find exciting and leaning into that, right. Like we often talk about our brain, but we don’t talk a lot about our gut and our heart, right. But those are things that it’s okay to follow a little bit in terms of finding out what’s going to make you happy, and where you’re gonna be the best suited in terms of where you end up in practicing you.

Manasa: Yeah, that’s awesome. If you had to pick one of your most memorable experiences that you’ve had throughout your journey, whether that was just something outside of or like the workplace or with a patient, or anything like that, is there one that you can point out for us?

Dr. Stambough: Oh gosh, I mean I don’t practice obstetrics anymore, you know mostly gynecology in terms of my practice, but there are certainly several deliveries that I can remember, and just the joy surrounding those, you know, like following somebody from the moment that you diagnose their pregnancy, to the moment that you deliver their baby. And the joy that goes along with that process, the joy that surrounds them both from the patient, and their partner, but also from the loved ones that come into the room after, just the happiness and kind of the wide open space they now have to start this kind of new chapter of their life. And then really being humble in terms of being able to be a part of that. And I can think back to several deliveries, and just how amazing that experience was and how privileged I feel to have been a part of that.

Manasa: Yeah. And then if a student wants to contact you, or just to shadow, have you as a mentor, to get involved with research or anything like that, how can they contact you?

Dr. Stambough: Absolutely. So you can email me, totally fine. I will say, give me some grace in terms of responding, right, kind of that 48 hour period, and if I don’t respond, email me again. Like please do that! You know, inboxes gets full pretty quickly, and so certainly, it’s not.. and this probably goes for anybody that you email – not that we are intentionally ignoring it but maybe that it got buried in kind of all the other emails that came after it. So please email me. Feel free if you see me, just to come up and ask to, and my phone number I’m more than happy to also give via email or to anybody that needs it just to text or call. But I’m always more than happy to have people in clinic. I’m always more than happy. I have so many research ideas, research opportunities, and then also kind of things in terms of chapters and publications that get approached about. And so in any way that we can get somebody involved, whether it’s just to know more about what we do or just to come hang out, we are more than happy to kind of help with that. Or to just sit down and talk about kind of where you are if you have additional questions, if you need any advice or help, by no means am I am expert in that field haha, but I am always to try to talk it out.

Manasa: Yeah, great. And is there anything that we haven’t covered so far that you would like our listeners to know?

Dr. Stambough: I mean I think we touched upon it, right, but there are going to be days that feel hard. There are gonna be days, where the score on the test is not what you wanted, where you leave your rotation and don’t get kind of the grade that you thought you should, or you take one of those standardized tests and it doesn’t come back exactly how you had hoped. And those feel really hard, like don’t get dejected. This is the big picture thing. This is kind of a marathon, not a sprint, for lack of a better euphemism, and so realize that those are kind of small blips in otherwise a big, long kind of career. And so you know, take a moment. Be sad, be upset. Be angry, kind of whatever you feel but then recognize that you’re doing what you’re doing because you’re meant for it. And so put that all to the side and kind of start back again with the same effort, with the same resiliency, with the same intention that you went into that with, and know that it’ll be fine. You’ll be okay.

Manasa: Yeah, it’s very easy to lose sight of that.

Dr. Stambough: Mmmhmm. Absolutely, I mean, I have the beauty of much more than 20-20 hindsight by this point, haha, but I still remember those moments where you start to have a little bit of self-doubt that creeps in, or you start to have a little bit of “Is this really what I should do,” or you know kind of the fatalism of what you think one score means for you. But recognizing on the other side of that, that if that is not really the case. And that if this is what you’re passionate about. If this is what you feel whole doing, then that’s what you’re meant to do, right, and so come back with the same resilience, come back with that same determination. Take some time to grieve whatever that is, or be angry, or be sad. But then, but then come back to it, right, Don’t give up!

Manasa: Yeah. Well, thank you so much, Dr. Stambough, for taking time out of your busy schedule to do this interview with us. I’m very excited for our listeners to hear about you, and your advice, and everything else!

Dr. Stambough: Awesome. Well thank you for having me! This is amazing, so thank you.

Manasa: Thank you. And listeners, if you have any questions, concerns or suggestions, please feel free to reach out to us. Thank you and see you at the next episode.

Introduction

In the fourth episode, we have a conversation with Dr. John Spollen, a psychiatrist at the VA and the Clinical Co-Course Director of the M1 Brain and Behavior module. We talk about his educational journey to medicine, the highlights of his career, and his work with ECT and Ketamine. Dr. Spollen is enthusiastic about his work with students, so we can’t wait for you to meet him.

Listen to Episode Four

Transcript 

Weijia: Welcome to the next episode of Mentor Spotlight, your very own UAMS-led podcast to help connect students to faculty mentors. We are Weijia

Hannah: I’m Hannah 

Jasmin: and I’m Jasmin

Weijia: Your hosts for this episode. Today we have Dr. Spollen. He has been clinical co-director of the M1 Brain and Behavior module since 2015 and has held several other leadership roles, such as co-chair of the evaluation and quality improvement subcommittee. He previously was interim chair of the UAMS Department of Psychiatry and the Junior Clerkship Director for Psychiatry. He is a professor and the vice-chair for education in the Department of Psychiatry since 2004. 

Hannah: Dr. Spollen has received many honors for his work in education including the educational innovation award, the master teacher award from the College of Medicine and the 2019 UAMS Chancellor’s award for teaching excellence. He’s been active in several national psychiatry education organizations. Dr. Spollen is the past President of the Association of Directors of Medical Student Education in Psychiatry and currently serves on the American Psychiatric Association’s Council on Medical Education. 

Jasmin: He practices at the Central Arkansas Veterans Health Care System, where he has held several clinical and administrative roles including his current post as Director of the Psychiatric Consultation Liaison Service and the Electroconvulsive Therapy and Ketamine Program for treatment resistant depression. He’s board certified in general psychiatry, consultation liaison psychiatry, and addiction medicine. It is an honor to have such an accomplished and distinguished faculty member interview with us today, so without further ado let’s get started. Hi Dr. Spollen!

Dr. Spollen: Hi, how are y’all?

Hannah: We’re doing great!

Weijia: We’re doing well!

Jasmin: We’re good!

Weijia: As we’ve introduced, you hold a lot of important positions here at UAMS and at the VA. Do you mind telling us a little bit about what your typical day looks like and how do you balance all these different responsibilities?

Dr. Spollen: So… so it changes a little bit depending what day the week it is but say Monday, Wednesday, and Friday we do ECT in the morning so it’s the first thing. I’ll try to get in about 7:30 and we usually do ECT until around 10. Then we have ketamine infusions from 10-12 so I oversee that. I don’t necessarily stay for the entire thing but I have to go interview the patients, make sure they’re doing OK, make any adjustments. Then I usually will try to go see a consult if we have a new consult. So we have a resident who goes to see the patient first and then they contact me and say you know “meet me on the Sixth floor we’re gonna go see Mr so and so” and I’ll go see that patient with them and then afternoon it’s either continue to see consults or some days we also cover the emergency room. So Tuesday and Wednesday we cover the ER, so we were down at ER before I came here today and then I also have to go to a bunch of meetings for my admin job at the VA, which luckily is on Teams so I just go to the office and log in and there I am. So yeah, it’s usually clinical work early and then afternoon tends to be meetings and stuff like this.

Weijia: OK that’s cool

Hannah: And so going into your background just a little bit, as a lot of students probably know there are multiple ways to kinda get into medicine. So would you tell us a little bit about your path to medicine and what led you to either pursuing psychiatry or just medicine in general?

Dr. Spollen: Well my mother made it very easy for me. She told me that I was going to be a lawyer, doctor, engineer or if all that failed, president. I had a limited option so I didn’t want to go to school forever so I originally started in engineering and I was in my second year of engineering and I worked summers at engineering firms before I decided I hate this and I hate everything these guys do for a living. So then I didn’t like the idea of becoming a lawyer, I thought president was totally unrealistic, so then I was down to medical school my mother actually knew somebody in the Department of Psychiatry. So I got a job working in the summer being a lab assistant and kind of got interested in the science of it got to go on rounds a few times with some of the psychiatrists there as a medical student, I mean as a college student, they don’t allow that kind of stuff anymore, but before HIPAA people could show up and go on rounds and I just really thought it was interesting. So I… I went to medical school thinking I would do psychiatry but not sure. Then during the clinical rotations I had peds first and I really like pediatrics and I thought oh maybe I’ll be a pediatrician but then I did psychiatry again in January after the… after the fall break and it just seemed kind of like a natural to me.

Hannah: I hope mine… I hope my processes is a “ahhh this is the one”

Jasmin: That’s really interesting since the last person we interviewed was Dr. Spond and he also went to school for engineering and then I guess he didn’t like hate it but he knew that medicine was more of his calling and went into medicine. So we were just talking about in the last podcast we did, how interesting it was how a lot of people don’t start off in medicine and kind of just find their way to it…so 

Dr. Spollen: Yeah I mean as I said…limited options

Everyone: laughing

Jasmin: hahaha you didn’t find your way… you kind of had the path already foged.

Dr. Spollen: Luckily it worked out. You know because I… I might have gotten to medical school and decided I hated doing that too. Luckily I was like oh this is actually kind of interesting and kinda fun…so yeah it’s worked out.

Jasmin: Could you tell us more about your educational background, meaning like where you went to medical school and where you did residency?

Dr. Spollen: Sure, so I grew up in Birmingham, Alabama and I well…I went to school at Auburn for a couple of years for engineering, three years actually, and then I transferred to Birmingham Southern which is kind of like Hendrix. It was like the pre Med school. I didn’t have good grades when I was in engineering and so when I met with people about trying to go to medical school they said you’re gonna have transfer to Birmingham Southern and make straight A’s and I did that and borrowed some money and then I went school at UAB which is the state school in Birmingham and… and that was a great deal. UAB was an excellent medical school and was very affordable back then. My tuition was $6000 a year.

Hannah: Oh my gosh 

Jasmin: Aaaahhh the dream!

Dr. Spollen: So actually Birmingham Southern was way more expensive for me than medical schools the two years I had to pay for private school was more than medical school and then I decided to do psychiatry and I did my residency in Charleston at the Medical University in South Carolina, where I lived on the beach my third year.

Hannah: That sounds like a dream!

Jasmin: We are landlocked currently so

Dr. Spollen: Charleston is a nice place so you’ll have to check it out. 

Hannah: I will, I am writing it down. 

Jasmin: Yes yes, so how did you end up here at UAMS for residency?

Dr. Spollen: Yeah well so in my training in the third year in residency, we worked in an outpatient clinic and so do the PharmD’s that are doing their psychiatry residency. We don’t have a residency here for PharmD’s but at USC, they had a big one. So I met this nice woman who was from Little Rock and I ended up marrying her and we ended up moving back here because her family was here.

Jasmin: oh that’s really cute. That’s usually how it works out right like a lot of people like during that time of your life right you meet up with someone that’s where you end up settling but yeah. 

Hannah: So we kind of know a little bit about how you got into medicine. Would you mind telling us a little bit of what your thought process or what led you to academic medicine and like in the academic field versus just being a clinician only. 

Dr. Spollen: So I…I won a teaching award as a first year resident and I was like wow, I never thought this would be something that I would be any good at. Then I won it the next three years too, and so I thought, well I interviewed for other jobs. I considered a job in the public health service for a loan repayment job because I thought academics would pay like nothing, this would help pay off my loans faster. But then it turned out to be not that different and I liked the people that I’ve met in academics and I like the idea of being a teacher and a clinician and maybe even doing some research. At that point, I was still doing some regular biomedical research clinical trial stuff like that. So it just sounded a lot more interesting than just… And actually a couple of those public health service jobs kind of scared me. One job I interviewed for I was gonna be the only psychiatrist for 3,000 people in Alabama…

Hannah: that would scare me too 

Jasmin: the epitome of rural health

Dr. Spollen: I was like this is an important job and somebody needs to take it but I don’t think it’s gonna be me. 

Hannah: yes well I can attest I think we all can attest to the excellence of his teaching. He taught my favorite lectures in the Brain and Behavior module but maybe that’s just because I like psychiatry.

Weijia: As someone with minimal psych background I will say I definitely enjoyed your lectures a lot too. 

Hannah: Very very digestible which is not always the case for every medical school lecture you’ll listen to so we appreciated that. 

Weijia: So how does a psychiatry differ from other fields and what kind of qualities do you think would make a person a better a student for psychiatry>

Dr. Spollen: No, I don’t know that there are any absolutes. We spend a lot more time just talking with people and having a relationship with people ’cause you have to make people feel comfortable for them to be allowed to talk to you about their mental health problems. I would say you have to have at least pretty good social skills. You have to like liking people and wanting to work with people. But I guess you could also say that about every doctor right yeah 

Hannah: At least the ones that have a lot of patient interactions 

Dr. Spollen: Not all of our patients are easy to work with and so you have to be OK dealing with some difficult people and I think sometimes actually that’s like in my role doing consults at the Little Rock VA. A lot of there…sometimes it’s just people that are acting badly because they’re super stressed out or you know, they’re uncomfortable. They don’t like people sticking needles in them but they’ll end up saying some dramatic thing like “Oh Lord! we should call psychiatry!” and really it’s just about how do you work effectively with difficult people. That’s kind of our specialty I think.

Hannah: So I was once told by a psychiatrist, it was like an off candid comment. They’re like you know, psychiatrists are really suited for hospital administration work because they are so used to dealing with so many different types of personalities and making a cohesive team that they’re really suited for hospital admin kind of work. Would you say that that is an accurate statement?

Dr. Spollen: Well certainly not all psychiatrists. We have some people who are bad at that sort of stuff. But I do think you’re right in that people who are very tuned into subtle non-verbal things will pick up on “this is not going well. I need to change my tactics for the better.” It does seem that we have a disproportionate number of people from psychiatry who are in these kind of leadership roles so yeah there’s probably something to that.

Jasmin: I think it’s interesting ’cause I feel like obviously most specialties have some aspect of psych in it. I shadowed palliative care and I was so shocked to see how much psych was like a component of that practice of building rapport with the patient and like a lot of these patients are dealing with things like PTSD. The same thing with family medicine or internal medicine… especially if you’re like a PCP,  you’re seeing the patient for the first time, and you’re having to recognize these multiple like psychiatric..  You know, if the patient is experiencing generalized anxiety which a lot of us are experiencing, like just post-pandemic or intra-pandemic so I feel like basically all aspects of medicine have a huge component of psych.

Dr. Spollen: yeah certainly, any direct patient care you’re gonna run into. Even the surgeons, you’re gonna run into people with PTSD. “We’re gonna put you to sleep…and then we’re gonna do this” and then the “Oh my God! Oh my God! Oh my God!” So yes, yeah everybody is going to end up with some mental health as long as you work with patients, you’re gonna eventually somebody with mental health problems.

Jasmin: With that in mind, I know we mentioned in our introduction that you work with ECT and the ketamine program. So that along with other research, why did you choose to specialize or do that kind of research? 

Dr. Spollen:  I’m at the Little Rock VA. That’s where medicine and surgery are. I do inpatient consults to medical and surgical patients. Well that’s why they do ECT as well because that’s where the anesthesia is. The person who was supposed to do it works at the North Little Rock VA and they would have to drive over here and do ECT and then drive back. So they just asked me if I would do it and I said sure. You would need me to get me trained on how to do it, because I have not done it in 20 years. So originally I just did it because they asked me to do it but it turns out, it’s actually been a lot of fun. When I took over ECT, ketamine was not a thing. I mean it was done in research but when I saw that it was likely to get the nasal spray version FDA-approved, I thought well, we’re probably going to have to start doing this. So I went to Yale where they had done all the early research with ketamine and learned about how relatively simple it is to do it. The one thing that is really nice about the VA is that we don’t have to worry about insurance. If you’re ineligible veteran, I can do anything for you. And so the thing in the community is that ketamine is very expensive. It costs you $500-$600 an infusion. You have to have get these over and over again ’cause they only work for a few weeks. So I was able to get a little training up there which the VA also paid for and come back and start it. Luckily since I knew anesthesia really well from doing ECT for several years, they were OK with me doing it, because anesthesia has to sign off on doing something with ketamine since it’s really their drug. The timing kind of worked out because we started doing the Ketamine program in December 2019, and originally it was just for people that ECT didn’t work for. But then if you remember, the pandemic kicked in a few months after that so I had a lot of people who were coming from maintenance ECT that would come like once a month or every other month to stay well who we couldn’t do ECT with because it’s an aerosol-generating procedure. So a couple of months of not doing any of those, I had people calling me saying “I’m really feeling a lot worse, when can I come in and get ECT?” and I said well we can’t do ECT but I have this ketamine stuff that you can try. I think we had six people who are coming for monthly or every other month for ECT. All of them did ketamine and none of them went back. They’re still seeing us for ketamine infusions every two to four weeks. So basically just took over a lot of the ECT business. 

Hannah: That’s pretty cool. I remember so one of my majors and undergrad was psychology and I took a psycho pharm class, and one of my professors was really into ketamine being like treatments for depression and everything, so I remember learning about this. But then I remember them saying this isn’t commonplace, so I’m seeing something in practice. They talk a lot in medical school about how different the curriculum is and just like new information they have every year and so I was like Oh my God, this is cool. Change happened in front of me.

Weijia: yeah I really just thought ketamine was for anesthesia. I didn’t know it could treat depression and all these other conditions. 

Dr. Spollen: And chronic pain. We have a ketamine program for pain infusion at the VA too. 

Weijia: oh OK 

Dr. Spollen: Yeah, it has several uses. For psychiatry, the interesting thing about ketamine is that it is a completely different mechanism. So up until now, every antidepressant that we have (other than ECT which is used for depression) everything else basically increases norepinephrine, endorphins, dopamine, and/or serotonin. So it’s all catecholamines. So every pill that you know of for depression essentially works the same way. Ketamine doesn’t do anything directly to those. So it works on completely new mechanism and so the pharmaceutical companies have realized this and they have now done a lot of trials trying to find things that work like ketamine in a pill so within a few years and actually one if public, would get FDA approved in the next quarter, so in the next three to six months, we will have something that is supposed to work like ketamine. I don’t know how well it worked, but it’s definitely spurred a lot of new things coming out and so my guess is probably in five to ten years, all those antidepressants that we taught you about in medical school, hardly anybody will be using. 

Hannah: Won’t have to learn all those SSRI’s. 

Dr. Spollen: That’s right. All new stuff. 

Jasmin: That’s usually how boards material works. Especially with cancer drugs now. Essentially everything that is in that book is essentially not used. 

Dr. Spollen: Right.

Jasmin: So I guess we can transition a bit topersonality outside of medicine. 

Hannah: Yeah so we talked about your background academically outside of work. What do you like to do for fun or hobbies to unwind just from a busy day or just in general?

Dr. Spollen: I’m pretty social. I like getting together with people and going out. I like traveling. I usually try to do one trip to Europe and one trip to the Caribbean every year. So my wife is a big beach person so we have to go somewhere with a beach at least once a year. Then I kind of prefer to go cities and travel like that. Although the beach is not bad either. Couple of big trips like that. Then work, I get to travel for work a lot which is really fun so those…some place where there’s a meeting. And of course, you know, I go to the meeting for a few hours a day but you have a lot of extra time that you can go travel around the city and see what’s going on so I like traveling a lot. I do like cycling but I mostly do it for recreation and exercise. And so I try to ride a bike a lot to try to keep myself healthy. 

Weijia: what’s your favorite city for travel?

Hannah: That you’ve been to.

Dr. Spollen:  yeah I feel like this is really hard…

Hannah: You can give us like top three.

Dr. Spollen: well I would say anywhere in Italy. At this point, I would say I actually don’t like any of the big cities. I prefer those smaller places in Italy where there’s less crowds. Lake Garda…San Giulio in Italy was amazing! Marina Del Cantone was a little fishing village on the Amalfi Coast was amazing. As far as bigger cities, Amsterdam was really amazing. I really like Amsterdam a lot. 

Hannah: I’ve had several people recommend that I visit Amsterdam. They’re  like, the city is beautiful.

Dr. Spollen: Yeah, and you can bike everywhere. 

Jasmin: Two hobbies in one. 

Hannah: yes yes! More affordable than gas. OK so, we’ve talked a little bit like outside of medicine. Kind of transitioning back a little bit into the healthcare field. Sorry, this might be like a tough one. What are some of your current frustrations that you have either within the field of medicine so like healthcare in general or just specifically within your specialty of psychiatry?

Dr. Spollen: So I think the payment mechanisms lead to a bunch of unintended consequences both in psychiatry and medicine in general. So we pay people for being sick. So we don’t pay people to prevent people from getting sick. So instead of paying primary care doctors a lot of money to help people quit smoking, we pay them to treat COPD and cancer. It doesn’t make a lot of sense. And for psychiatry, pills are cheap and therapy is expensive. So they generally want to pay for pills and they don’t want to pay for psychotherapy which tends to be like 12 weeks of seeing a psychologist or social worker so that’s a lot more expensive than you know, give you Prozac. I think the finances unfortunately lead healthcare to be more about illness care than healthcare

Jasmin: Yeah I feel like especially with our current healthcare system, specifically to the United States, there’s a huge hole for preventative medicine and just even preventative medicine like counseling on preventive medicine.  I feel like we’re not often like…it’s not really super emphasized in our current curriculum. 

Dr. Spollen: Right, there’s so many people who should basically have a health coach that they meet with a lot to help get their life back, to help  get them eating better, moving more, drinking less, and smoking less. Yet instead, you see a primary care doctor and they prescribe medicines for these things that really should have been preventable a long time ago. That’s one thing that’s really nice about the VA. We are kind of one of the few systems in the United States, the biggest system that’s basically it, kind of socialized medicine system, where we care for most of the veterans from the time they start coming to VA until they die. So there’s a little bit more of a focus on whole health and trying to prevent illness rather than just treating it. It lets us be a little more flexible about how we set things up because we’re not necessarily paid by a certain service. We have to justify our workload by showing people CPT codes and all that kind of stuff that everybody in the rest of medicine does, but it’s really just so that the VA can say yes but the people are working. But as far as providing care for people, insurance has nothing to do with it, and reimbursement has nothing to do with it. Hence the ketamine program, which nobody in the community can do a ketamine program like we can in the VA because they have to worry about paying for it and I don’t. I think I can just say this is really good, people seem to be getting better. Let’s see if we can do it as long as I can get through the bureaucracy, you can eventually do right. 

Hannah: Gotta cut all the red tape first. 

Jasmin: That’s why I loved seeing or shadowing at the VA. I saw that a visit was 30 to 45 minutes where we could really sit down and talk with the patient. Especially with veterans who have long histories of PTSD. You have to do the suicide screening. You have to really get into the nitty gritty. So yeah I think the VA system it’s like kind of a model that we can have hopefully for like the greater…but that’s a huge wish. 

Dr. Spollen: Yeah, but it works too!

Hannah: Room for improvement but also some commendable advantages. 

Dr.Spollen: I’d agree.

Weijia: So do you think there are any implementable changes that we can put within our healthcare system?

Hannah: big or small.

Dr. Spollen: Yeah I think what they were moving that direction with unfortunately kind of got slowed down but some of the Obamacare stuff about paying. In fact, the day before y’all’s time, there was a move to manage care which basically put insurance companies in charge of deciding what they’re going to do or not. I thought what Obamacare did was really put healthcare systems in charge of it so instead the insurance company basically became UAMS and Baptist or some other large care system, like Kaiser. And then it was up to them decide what we’re gonna do and so you would have to make strategic decisions about things that are medically appropriate and necessary and make some things that are reimbursed for in the community but maybe aren’t that important and maybe we should be doing less of that so we can do more of this. But I think that the decisions in those cases are made by the healthcare system rather than just an insurance company.

Jasmin: a lot of policy making that even involves people outside of health care too so it can get pretty controversial pretty fast.

Hannah: the downfall of a capitalistic society. 

Everyone: *laughing*

Dr. Spollen: Capitalism also has its benefits and its problems

Jasmin: I feel like I think it’s really interesting to even study like other healthcare systems in other countries and how they set up you know payments and everything. You’ll have like the United states as like one extreme and then you have like European I guess…

Weijia: Yeah, universal healthcare. 

Jasmin: Yeah on another extreme and I think it’s all about finding a healthy medium but even that’s really difficult.

Hannah: No system is perfect. It’s just trying to maximize, I guess, what’s working for you. Alright so kind of just another broad question but just, what is one piece of advice that you would give to any medical student regardless of what kind of…what specialty they wanna go into or like whatever they want to do…just a broad piece of advice.

Dr. Spollen: I think you have to pick a field of medicine that you’re going to be intellectually interested in so that you will read because you need to read a lot if you’re gonna keep up. So you don’t wanna be one of those doctors that practice is just like they learned in residency 20 years later. So you have to, you know, they’re gonna send you journals to your house, and if you don’t really like it, if you’re not really interested in some of that, you’re gonna put it in recycling. And then you’ll become a dinosaur. You’ll be a bad practitioner. So you’re gonna stay up to date and you’re really gonna like your field, you gotta be intellectually interested in it because there’s a lot of work to be done to stay up to date. That’s like a big one. I would say when you’re going through the third year, look for what you feel most comfortable in, what you go home and feel excited about, what do you talk to your significant other about, and you know, try to see if you can find something that seems like a good personal fit. You know, most of these jobs pay a lot more than what your parents may. A lot more than what you really have to have to live, so you know, pick something that you’re excited about ’cause then you can still be excited about it 24 years from now. 

Hannah: So just out of curiosity, I know like different licensed professionals have different numbers of continuing education hours they have to receive. What is like the standard for most medical clinicians for how many hours of continuing education do they technically have to have?

Dr. Spollen: So I think it is state by state. It’s 30 hours for our state.

Hannah: OK 

Dr. Spollen: So it’s not not bad you go to a couple of meetings and you can easily get it. I think it’s harder for people who are in private practice, who don’t need to go to these meetings that I get to go to and get 20 hours one weekend. 

Hannah: Right 

Dr. Spollen: But you know one thing you can do is…you could actually get hours by just reading articles on like Medscape and so you can sign up for those things and just every time you read an article you know… sometimes they ask you to go answer a couple of questions but it’s basically rewarding you for like on the fly learning like “oh I’ve got somebody with hypothyroidism, let me make sure I still know what the heck I’m talking about.” Go read UptoDate, boom, got an hour of CE right there.

Jasmin: I have heard that from multiple people like multiple mentors we’ve interviewed or like even some attendings that I’ve talked to you like in my other program about how a lot of them have the habit of like reading one article a night or something. They make it a habit or something to… to like keep up with the current literature.

Dr. Spollen: I tend to maybe be more case based like we get patients who come in who have X problem and it’s been a few years since I’ve seen X problem. So I’ll spend a little bit of time that afternoon when I get in between things just downloading a bunch of articles. Then I may go home and read them that night if I haven’t been able to read them. But to me it makes better sense to.. I do like further journals I get at home, I will scan them if there’s an article that’s pertinent to me, I will go ahead and read that sometimes there are not that many, like one thing out of entire journal but… but I find that at least in my job because there are certain things that I see a lot of that I tend to keep up naturally because we see a lot and then there’s some things that you don’t see very often and so I have to go back and kind of relearn that to make sure that I’m up to date on what it is that we’re recommending. As a consult psychiatrist, I get called to basically see someone and then explain to medicine and surgery what’s going on and what the plan is. So I kinda have to keep up to date ’cause a lot of people are reading my notes so I don’t want to say anything stupid.  Unlike in private practice where the only people reading my notes is me, at the VA I it’s it’s totally secure as people can read anything so I’m always kind of feeling like “eeehh, I’m gonna make sure that I stay here is right” so if I start typing something I’m like not sure about then I’ll stop and I’ll go look it up online or even article or two and just make sure that what I’m saying is accurate ‘cause you never want to lose face and say something foolish in the medical record where it stays forever. 

Jasmin: PCP’s will read that, that will just be like in there forever yeah 

Dr. Spollen: I use voice dictation and so you gotta… you gotta worry about what it’s gonna say ’cause it’s always English, it just may not be what you said. So one time I had this really nice lady and back then they were really begging for us to take a social history that included hobbies, so I was going down- “what’s your hobby” and she said cooking. Later on I went there and dictated it, the computer misinterpreted me and thought I said cocaine and that was still in her note when she came back a few months later.

Hannah: They were probably like “Oh my gosh…umm”

Dr. Spollen: I put a little addendum- by the way, above incorrect, it should say cooking not cocaine. So yeah, but that’s still in the medical record 20 years later.

Hannah: Gotta work on getting rid of some of my… my country accent.

Jasmin: That’s really funny. So my aunt in the Philippines, you know they… they allocate a lot of these jobs or medical like medical transcriptionists to other countries, other English speaking foreign countries ’cause of cheaper labor. So my aunt used to like, they would send her the voice recordings and a lot of times it was for like surgeries and sometimes while I’m there during the summer should be like “hey Jasmin, can you come here. Do you understand what they’re saying?” and I was like, noooo. I even have some medical knowledge but I’m still like “I think they’re just really tired” ’cause you know like when, especially when like physicians, surgeons are so tired they’re like mumbling. So I was like oh this is all mumbling and she’s like “OK”. So I… I think computers are a lot smarter now so probably they’re phasing that out but jobs like that very well still exist. 

Hannah: Need to work on my enunciation

Jasmin: Yeah and I think less… this is kind of an off track but as future doctors we need to make sure that we enunciate really well because there could be situations like that where you get cooking and cocaine mixed up.

Dr. Spollen: Whoops

Jasmin: It can very well be a part of patient care.  

Hannah: Yeah one is definitely more of an eye blinker than the other one. Okay, so if you wouldn’t mind, what is your most memorable experience either from medical school, residency, as an attending, like in your just general practice, either most like memorable or 

Jasmin: life changing kind of just changing your perspective

Hannah: you thought it was like really cool that you would like to share slash can share 

Dr. Spollen: Yeah, I can probably share most things. Yeah, I don’t know that there’s one thing. I mean you get these things all the time. I had somebody give me a present today. I had a guy who made a pen and brought it in for me and was like “I want you to have this. You have really been helpful and I am really appreciative of what you have done”. I was like I think I can take this, I figured theres a government rule that says I can’t do that. When people get better and… and are… are really happy that whatever we’ve done has really been helpful, which is surprisingly common in my job, maybe it’s ’cause I’m giving people ketamine all the time and this actually was an ECT patient so you know maybe some of the things I do tend to be pretty helpful for people who felt pretty miserable so you know I think those are the kind of things that are kind of fun. There’ve been a few kind of like cool moments when I figured something out like when other people hadn’t and I was like FINALLY… I got to you know… I’m the consult psychiatrist and I was actually able to figure out what was going on. We had a guy who’s having visual hallucinations and we have no idea, his labs looked fine and I just started going through every drug he was on, looking for a drug interaction ’cause I knew it had something to do with the medicines he was on and I figured out it was vortioxetine, this drug, not vortioxetine, voriconazole. He was on vorioxantonizol and was taking inhibitor of that so he was getting really high levels from it and you get hallucinations with toxicity with voriconazole. Had the same thing with somebody who had encephalomyopathy from…oh what was it… they had balance no, acyclovir. So they.. they came in, they’re getting treated for some kind of herpes thing with acyclovir but they had renal failure and so they haven’t renally dosed it and so this guy was completely and encephalopathic and acting wild and tearing up the emergency room and it’s just ’cause I went back there and kind of went through methodically through all the things. You know, I narrowed it down to: medicine hasn’t figured this out, which means it’s probably nothing in their domain. It’s probably one of these pills that he’s taking and so I went there and kind of investigated, figured it out. Then went back out to the ER and was like “I know what it is! Here’s what we do!” So sometimes that’s kind of fun, which in my field you don’t have a lot of gotcha’s in psychiatry. So it’s nice when you… when you get it right. There’s so many things in medicine when they call us and it’s like this guy is delirious and I’m like “yeah I totally agree, I have no idea why” and we just don’t even figure it out but that’s a third of the people that we have are delirious between all those consultants, medicine, and neurology, psychiatry we never figure it out. When you get into clinical stuff, the first few years there’s a diagnosis and there’s a treatment and you know what it is and you know what to do. Then you start doing like wards and it’s like “we don’t exactly know what’s going on with this guy.”

Hannah: Right you learn there’s an answer ’cause there has to be an answer on the test but in real life not so much.

Dr. Spollen: If you want to learn, Nick Gowen from the VA writes amazing notes, where he will go through exactly what the thought processes are and you get down to the bottom you’re like… he just says it in such a matter of fact way like “we have considered many things but we still have absolutely no idea what this is.”

Jasmin: I’m sure you don’t really figure or like you figure things out more as the disease progresses, you know with time right ’cause like more symptoms show up right? 

Dr. Spollen: Yeah … yeah I had…

Jasmin: It’s a waiting game.

Dr. Spollen: I had sort of an unusual gotcha thing when I was in medical school on my Peds rotation, probaably one of the reasons why I liked it so much. I had this kid that got admitted with you know vague kind of fever but he had a platelet count of like 700,000. I was like that seems odd. Maybe it was a million, it was like seriously seriously high. So I was like I wonder if that’s a clue and so I started going through the book of everything that had thrombocytosis as an option and I just went through and kind of like ended up saying well it can’t be that, can’t be that, and then I got to Kawasaki’s Disease and I was like well what else we looking for? It’s like desimation of the fingertips. I went back there and looked didn’t have it, six hours later he had it and it’s sort of played out… like overtime you could see these other things show up and it’s like I think this might be Kawasaki’s Disease and the next morning I presented it as that and the resident was like yeah kind of doubtfully and the attendant was like you know could be but it’s so rare but you know four or five days later it turns out that’s what it was. We had you know he had cardiology and they’re saying “Oh yeah that’s what it is” so it’s you know kind of one of those things that kind of played out and it played out over my night on call so like you know presented it like you know 6:00 PM and by 10:00 PM I’ve got a list of six things it could be and by you know three of three o’clock this morning I’m like “Oh my Lord I think that’s what it is”

Hannah: It’s just like hmmm it just keeps getting more similar

Jasmin: So the beauty is just like all those Eureka moments that you have in medicine. It really is just like…

Hannah: Very satisfying 

Weijia: Yeah sounds like stuff you see on TV, it’s kinda cool

Dr. Spollen: Most days are not like that 

Hannah: If they teach you anything in med school, it is that medicine is not like you see on TV Weijia: Yeah, no, no only certain moments 

Jasmin: So as we’re wrapping up, how can a student contact you if they wish to ask you a question, shadow you, or just in general want you as a mentor someone to ask questions?

Dr. Spollen: They can just email me! I’m the only Spollen in the global.

Hannah: Okay, perfect and then is there anything that we haven’t kind of touched on in this interview that you wanna add in? Anything you think is like vital to it or just any lasting thoughts? It’s okay if you don’t have any, we just wanna make sure that we’ve covered everything that you know should be covered.

Dr. Spollen: Yeah I should prepare for that, to have one last thing.

Jasmin: No is a good answer too

Hannah: It’s okay, I think you would probably be like.. if you actually had something I think you probably feel like the first one.

Dr. Spollen: Yeah…no…no I can’t think of anything, sorry.

Hannah: That’s okay!

Jasmin: This was a great interview in itself!

Hannah: Well thank you so much for being available for this podcast and for your dedication to student education… so … and listeners as always reach out to us and let us know your thoughts, concerns, questions and we’ll see you in the next episode!