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December 22, 2009
2009: Changing jobs, and the other side of the stethoscope

I tried to resist the urge to write an end of the year column, but since it snowed so much here in DC, and people around here donít know how to drive in the snow (myself included), I have to do something to release my creative energies. So here it goes.

This year, I joined the hundreds of hospitalists who went out on the job market. Even though the economy was bad, it seemed there were plenty of jobs out there for pediatric hospitalists. Granted, I had to wait a little while for a position to open at the place I really wanted to work at (my current hospital, Inova Fairfax Hospital for Children), but I finally got the job.

I learned plenty during my job search. The best lesson was that, despite all the ads in all the journals (this one included), I found most job openings by directly e-mailing or calling the directors of the various hospitalist groups. I did use one recruiter to put me in touch with another hospital, but for the most part, I relied on the tried and true method of direct communication. Thatís one of the benefits of the current state of pediatric hospital medicine: Itís still a fairly small national group, so if you go to one of the conferences, you'll have the opportunity to meet enough of us to establish the connections you need for a job search.

As I wrote on my most recent post, once you get the job, itís important to lay low for a while, learn the system and not pretend youíre Godís gift to the organization. That being said, make sure you find out early on how you can make your mark. I think the most important question I asked during my interview process was: "How do you see me fitting into this organization?" Establishing your potential contribution to the group helps in planning for long-term goals, and facilitates the transition to your new workplace.

My other experience this year had to do with being on the other side of the stethoscope. Due to various illnesses among several family members, I rediscovered the many stresses and frustrations that our current health care system can generate.

I saw how complicated our medical system is, with its tests, consultants and procedures. I saw how a simple symptom could generate a large hospital bill, making me wonder how people who are not medically trained put their blind trust into our hands, hoping we will do the right thing. I also learned that, for the most part, doctors try to do the right thing, but we are completely blind to the cost of our intentions. And Iím not just talking about the financial costs.

I believe that the principal challenge to health care is in the area of communications. Specifically, our challenge is to become interpreters and translators, not only interpreting the intricacies of medical science, but translating it in plain language. We should learn from our nursing colleagues and become better communicators.

That doesnít mean we have to dumb down the conversation, but certainly there are better ways to explain sepsis, abscesses and hypertension in simpler, easier-to-understand terminology. In this sense, I think we pediatricians may do a better job than most. Why? Because our patients are kids, and when parents have a sick child in front of them, the more basic the conversation, the better it sticks.

That doesn't mean you need to start referring to your patients' incision as a boo-boo (unless they are four years old). But realize that, in illness, the brain is focused on only one thing: suffering. Because of that focus, high-minded conversations about sensitivities and effectiveness go unheard or misunderstood.

I remember a specialist coming into the room of one of my family members who was lying in bed with IV lines infusing antibiotics and pain medicines. The specialist launched into a talk on the duration of antibiotic therapy, the effectiveness of the treatment, and surgical margins and pathology slides.

The only word that crossed my relative's threshold of pain into the part of the brain that was barely aware of the conversation was "tumor". And even though the context was positive, the surrounding verbiage was unintelligible to anyone untrained in medicine. And that scared her.

Another specialist insisted on chasing a barely abnormal blood test without fully explaining why. And while I was there to help assuage my relative's fears, I wondered about the countless other patients who go through moments of dread because of a poorly worded phrase, an unfortunate choice of words or a less-than-reassuring gesture.

So here's my new yearís resolution for all of us: Let's all become better. Not technically better because I think we all intuitively strive to do that, but to become better communicators. I believe this will help us become better doctors.


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About Ruben J. Nazario, MD
Ruben J. Nazario, MD, is now medical director at Inovalon, a health care data analytics company, and is medical editor for Elsevier's First Consult. A pediatric hospitalist, Dr. Nazario is a veteran of both community and academic pediatric hospitalist programs. All material represents his own views and does not reflect the views of his employer.
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