Looking Inside Medicine—Interviews
Interviews with faculty, healthcare providers, or other inspirational professionals.
Psychiatrist's New Clothes
Caroline Quynh-Huong Nguyen
The University of Texas Medical Branch–John Sealy School of Medicine
[CAROLINE]: Good afternoon, my name is Caroline Nguyen, a second-year medical student. I have the pleasure of interviewing Dr. Chandler Self today—if you want to go ahead and introduce yourself and tell us a bit more about what you do!
[Dr. Self]: Hi, I'm Chandler Self: I'm a psychiatrist at UTMB and also the Assistant Dean of Academic Support and Career Counseling, a job that I started in July of 2022. I am so excited, and thank you so much Caroline, for having me here today.
[C]: How did you get to where you are today…can you walk us through your entire journey? I'm sure it was very stressful given that you have so much on your plate currently.
[Dr. S]: It's been a wild ride I would say, becoming a psychiatrist today. Starting from the beginning, I grew up in Rockwall, Texas, which is a small town on the east side of Dallas. I went to public school all the way through. From there, [my sister-in-law] threw the javelin for the Texas A&M track team, and I was running cross country in high school. I desperately wanted to run cross country in college, so I walked right up to the Texas A&M coach at an invitational meet when I was a senior in high school [and I said], “Coach Hartman, I’m not the fastest runner at my high school, but I will work harder than anyone else if you let me walk onto the team. He invited me to walk onto the team, and I ran cross country and track and field for all four years… I worked, I followed the training regimen, I followed the program that my coach had for me, and ended up earning a scholarship as a student athlete at Texas by my junior year and traveled all around the country (back when Texas A&M was in the Big 12) and really had a great experience. Those values that I learned running cross country and track and field in terms of determination—making it to every single practice on time, doing all the work, eating right, learning how to persevere through pain, learning how to tolerate that feeling of [discomfort] of like, “Okay, this, this is painful to be running at this pace, this hurts, but I can do it, I can handle it.” I think that was a valuable lesson for me moving on to medical school here at UTMB, and so when the study load became so intense here, as it does in medical school, I learned how to push through the pain when it didn't feel good to study, when I wanted to get up, when I wanted to go do something else, when I wanted to relax, when I wanted to go to the beach, and it was like, “I don't understand the spinal cord yet. I need to sit here and study longer.” Learning to tolerate that pain was something that I learned in running. From there, I really wanted to do my residency in New York City. That was where I wanted to learn psychiatry. I wanted to move to New York… I had been living in Texas my whole life. I wanted to move to New York City, and so I applied to all of the Manhattan programs, a few Brooklyn programs, and a couple Bronx programs. I interviewed, and I was accepted at Mount Sinai Beth Israel in the East Village and learned so much living in New York City. They say, “What doesn't kill you just makes you a New Yorker.” Living up there was very, very difficult… snowing and walking and carrying your groceries home and riding your bike around town and waiting on the subway platform. It was just such an interesting experience, and I really valued the lifestyle grit that I had learned. At [that] point in my life, [I’d] learned running grit, I had learned study grit, and now I was truly learning lifestyle grit—how to get by on a resident’s budget, living in a very expensive city, and having to survive in that way. One of my favorite parts about living in New York City is that I also experienced the other side of what we're talking about today with grit and glamour: I learned the value of the arts. Everybody in New York City was so creative… people were playing music, people were into Broadway shows, people were into dance, people were into painting, making pottery. I mean, people were just interested in so many aspects of the arts, and of course I think an area of art that I really valued living in New York City was fashion. I really was inspired by everybody around me who could put together these fabulous outfits, and it wasn't so much that they were expensive or elaborate, but they just represented who they were. I loved seeing people wear clothing that didn't conform to any social norms. Oftentimes, what they wore was culturally influenced from their family backgrounds. It was artistically influenced by designers that they enjoyed. It was an expression of who they were, and I really valued that part that I learned in New York City. Anyway, long story short, after living in New York City—I lived there for seven years—I decided that I was ready to come back home to Texas, and that's where I started my job here as a psychiatrist at UTMB. I took some of that love for fashion back with me to Texas and also kept with me that lifestyle grit that I learned in New York City, that studying grit that I learned here in Galveston, and that ability to push through pain that I learned from living at in College Station at Texas A&M.
[C]: Thank you for sharing! How would you say that you carry your sense of fashion with you today, as a psychiatrist?
[Dr. S]: [It's one of the things] that helps me prevent burnout. [I think in medicine we talk a lot] about, “How can we prevent burnout?” Well, maybe we need to go do yoga. We need to eat vegetables. We need to make sure we exercise. We need to make sure we get to bed early. But, what about the fun stuff that helps you get through burnout? Yes, you can do things at home like cook nutritious meals and have fun with that, and everybody has their different ways of making life fun, but as you and I have talked about before, one of the things that helps me go, “Cool, I'm excited about today” is having a great pair of cute shoes to wear. It really is something that I see all throughout the day. It's something that other people often notice. The patients love it; it brightens their day. They go, “Wow Dr. Self, that's a wild pair of shoes you got on.” Or they don’t, but either way, it's something that I look at all day, and it makes me happy to have a colorful pair of shoes to wear. It's not every day. In fact, on Monday I remember I was like, “I just got to get to work.” Sometimes, that meant a pair of Keds sneakers, a button down, and pants, and I was good to go. It's not every day, but I will say that it is something that helps me to prevent burnout, and burnout is always such a serious topic that we talk about—and it is serious, but there's some lighthearted, fun, superficial, non-evidence-based ways that we can all get through the day. For me, wearing a cute pair of shoes is something that is lighthearted and helps me.
[C]: I'm not sure if they can see it, but you’re wearing a cute pair of shoes today! Me too, I love my [current pair of] heels. I was doing a Family Medicine preceptorship this summer, and I noticed that my patients really appreciated not only my disposition—the smile on my face, being excited to come to work—but also the outfits I would put on; the shoes I wore, as well, so I totally understand what you were talking about with your patients!
[Dr. S]: Our appearance is individual and unique, and it's okay to have a little bit of fun with it in medicine. I think sometimes we're in fields, and we're in times in our lives where we are studying so hard, and we are working so hard, and we have so many patients that need us that it's impossible to even think about what you're wearing. That is just the last thing on your mind. You are pulling a 30-hour shift, the pager is going off nonstop, and the last thing that you can think about is what shoes you're wearing. That is a very real issue, but I think what's important is…okay, so for me it's shoes, but for anybody else I think it's what brings you joy. It might be making sure that you have a really good sandwich to look forward to at lunch or that you find some time in the day to spend five minutes out in the sun, and just feeling the sun hit on your face. I think everybody has our little superficial, small things that we need to do to be able to get through the day, and shoes are not for everybody, but they’re certainly something that make me happy. I'm glad that you had a similar experience as well, where you realize that people do notice in the clinic! They pay attention, and I think that's nice.
[C]: Dr. Self, to kind of close off this interview, could you give your opinion on the definition of grit, in the wider context of the field of medicine?
[Dr. S]: I think grit is what I talked about a second ago—that capacity to endure. When I think of grit, I think of clenching your teeth in an effort to push through, and it's not easy. You and I have talked before about the emotional toll that psychiatry can take, and it does take a strong constitution… to witness human suffering so intimately. No matter what field of medicine you go into, that is our charge. We are here to heal, to provide comfort, and to bear witness to a fellow human’s suffering, and I think that is what grit means to me in medicine. What little happiness we can bring in that arena—whether through a bright color or a smile or a comforting word or a touch on a hand—I think these are all ways that various different physicians throughout time have found ways to heal besides just prescribing medications. I remember a physician who didn't have anything left to give to a patient because the illness was terminal. He said, “I don't have anything left to provide, but I do know how to play ‘Amazing Grace’ on my guitar.” For that physician to be able to provide that beautiful music in that moment is, I think, all part of what having grit in medicine is about.
[C]: For sure. Well, thank you so much Dr. Self. I really love your insight and perspective on what glamour and grit mean to you in the context of medicine. I love how you found a way to cope with the stressors of your everyday work [and the] field in general. Thank you so much for your time. Thank you for sharing!
[Dr. S]: Yes, of course! Thank you so much for having me! I've enjoyed it, and I hope everyone can find their way of experiencing those little colorful joys in our days.
Grit and Glamor
Madelina Nguyen
The University of Texas Medical Branch–John Sealy School of Medicine
One thing that I would like to include with my student-faculty interview is the amazing glamour that accompanies the career of the faculty I interviewed. It was very briefly touched upon, but Dr. Rogers has received a countless number of awards and honors throughout her career, which serve as a testimony to her commitment to the noble ideals of medicine as a pediatrician and educator. Dr. Rogers serves as a key contact for legislative issues involving health care reform with the American Academy of Pediatrics. She has served on the Board of Directors for the Galveston County Health District and has received numerous awards for her significant contributions to education, including the induction into the UTMB Academy of Master Teachers in 2007, the Pediatric Educator Award for Excellence in Medical Student Education, recognition from the UT Board of Regents as a Distinguished Teaching Professor, Teacher of the Year Award of Excellence from the residents of Family Medicine, and the Department of Pediatrics Golden Rattle Award for the Excellence in Clinical Teaching (twice!). Dr. Rogers was also one of the inaugural recipients of the John P McGovern Academy of Oslerian Medicine Excellence in Clinical Teaching Award. Listed among the Best Doctors in America since 2005, Rogers has also been featured in the Texas Monthly Magazine as a super doctor. In 2020, she became an Emeritus William Osler scholar and was listed in the Waiting Room Magazine as a top pediatrician in Texas. These are only a few of the many honors bestowed on Dr. Rogers, but it took her a lot of resilience and grit to get to where she is today. On a fundamental level, she serves as a caring pediatrician and a strong mentor and teacher to others.
[Madelina]: Hi everyone, my name is Madelina Nguyen. I'm a second-year medical student at the University of Texas Medical Branch in Galveston, TX, and today I'm joined with Dr. Patricia Rogers, a professor of Pediatrics at UTMB in Galveston... she serves as a mentor and faculty for many residents in the department of Pediatrics. She completed her medical degree from the University of Tennessee College of Medicine at Memphis in 1981 after graduating from Vanderbilt University, and she completed her residency training at UTMB in Pediatrics as the chief resident. She also spent 13 years in private practice at Plano, TX, and then in 1998 she returned to UTMB as faculty and has led various committees at UTMB since then. Throughout her career, she's received many honors and awards. The most recent accomplishment was in 2021 when she was included in the new edition of Women in Medicine and is listed among thousands of other influential doctors. So, thank you for being here with us today. Would you like to tell us a little bit about yourself?
[Dr. R]: Thank you! I wanted to start with way back when, when I was three. People would ask my parents, “What does she want to be when she grows up?” That’s a weird question to ask a 3-year-old, but I was pretty precocious. So, I would say “a baby doctor” instead of pediatrician. It was the same thing: baby doctor. And they would pat me on the head and say, “Oh that's sweet, but you can only be a nurse.” So, my parents would say “If she wants to be a nurse, she can be a nurse. If she wants to be a doctor, she can be a doctor.” I had very supportive parents, and that's when it all started. The person who really influenced that was my pediatrician Dr. Bisson. I worshipped him, he was great. And you can see the influence he had because I'm a pediatrician now. That sort of guided my life as far as Pediatrics being my calling. I would do things like, when I was at Vanderbilt, I did some volunteer work at the hospital with children, and in the summer I worked with children. Then lo and behold, I was accepted into medical school. I did my undergrad training at Vanderbilt, where I majored in mathematics and minored in chemistry. The thing about mathematics was if I didn't get into medical school, I could teach at college… mathematics. Anyway, then after medical school, I did my residency at UTMB in Pediatrics and stayed on as chief resident with Dr. Daeschner. He said I should stay on as an academician, but I wanted to try my wings at private practice and that's how I ended up in Dallas/Plano. I was there for 13 years. I ultimately was in a very lucrative private practice with a total of four pediatricians, and I was enjoying Pediatrics. Things started to get sort of monotonous, kind of old—little ears and runny noses and ADHD. I mean, there was a gamut of what we saw in Pediatrics. Dr. Thompson here in family medicine and Dr. Richardson wanted me to come back to UTMB to be the medical director of the health department. That was something I had never done before, so I did it! That was a change and later I'll talk about not being afraid to make a change. The interesting thing about that—the health district had never been JCAHO approved, and they told me, “Surprise! You get to get us JCAHO approved,” which was a major undertaking, but we did it.
[M]: Yeah, that’s a big task.
[Dr. R]: We did it. Anyway, fast forward, I was back in Pediatrics in my element, and the reason for the change was I wanted to teach. I teach residents, I teach medical students, I wanted to see patients. I see my patients, and I'm on a lot of committees, unfortunately. I need to wind down. I've managed to get several awards and honors, so that's where I am. You have a little document that sort of list different awards and different things, but that's who Pat Rogers is!
[M]: Awesome, thank you for sharing that with us. You've had a very robust career. I'd say a lot of moving parts.
[Dr. R]: A lot of moving parts, yes.
[M]: So, what would you say your hardest obstacle was in getting to this point in your career?
[Dr. R]: I didn't experience much as far as racism at Vanderbilt. The good thing about Vanderbilt; it was obviously an international school, and you could pick and choose your friends, and I had my group of friends from different nationalities. It was great. They were my buddies. In medical school, there were some racists, and the big obstacle was Dr. Peter Jones. I remember him very well. He was from South Africa. He didn't feel that African Americans should be doctors—He pretty much told me that, and then his statement was, “If they go to medical school, they should only go to Meharry,” which was a medical school that was predominantly African American in Nashville. So that was an obstacle. You know, there are obstacles with being a woman, but that didn't stand out as much as Peter Jones.
[M]: I'm sorry you had to go through that. I feel like now it's a lot better from what I've heard. So, the next question I have for you is more on the patient care side of things. As a pediatrician who works with kids, how do you cope with the emotions that you feel about human suffering that you experience through some of your patients?
[Dr. R]: I think the biggest way I cope with human suffering is with empathy and compassion. Yes, we see some of the bad sides of Pediatrics. For example: kids who've had trauma in their life, kids who've been abused. The big thing is having resources and knowing what resources to tap into. For example, we have an abuse team with Patricia Beach as the head, and we can use that resource for kids who have had a traumatic life. We have a social worker, Pam Massey, who does an excellent job at helping parents and helping kids; particularly kids who don't have food and kids who are in a terrible home situation and other things. We do referrals for counseling, particularly with adolescents who have anxiety or post-traumatic stress. So those are the things. That's the way I handle the human suffering part—is having resources that I can use. In general, human suffering—the big thing about Pediatrics is kids do bounce back. An example is that they can be sick as a dog, and they can make adults pretty sick as a dog. Adults kind of linger for several days but the kids do bounce back. They're out playing after they've been really ill.
[M]: Well, it seems like you have a good team of support. I feel like you need that and can't just handle it all by yourself.
[Dr. R]: Yeah, I try not to handle it all by myself.
[M]: That leads me to my next question: Do you have any habits or practices that you have done in your career that help ground you in your ideals as a physician?
[Dr. R]: I think the biggest thing that has grounded me is God and prayer. My favorite verse is Philippians 4:13 “I can do all things through Christ who strengthens me,” and that's it. My humanity through Him has helped, so that's the biggest thing through my career that has grounded me.
[M]: How do you practice that in your daily life?
[Dr. R]: As far as God and prayer, remembering that God created everything, and I don't think He wants kids to suffer, so I'm busy doing my job to make sure the kids are well and doing preventative medicine as well, but mainly taking care of kids.
[M]: You have done a great job so far. I've heard a lot from other physicians as well about how great of a pediatrician you are.
[Dr. R]: Thank you.
[M]: So, my next question is: as one of the most recognized and highly decorated physicians at UTMB and in the state of Texas, what does grit mean to you?
[Dr. R]: Grit! I'm not sure I understood that question.
[M]: Well, I did hear a little bit about how you gave us advice at the Pediatric Student Association (PSA) meeting on being resilient as we're going through medical school and through your career, so, my question was what did that mean to you — resilience and grit?
[Dr. R]: I think there are two things: one is having “stick-to-it-ness” and sticking to and having tenacity has been the thing as far as my grit is concerned. The other thing I tell students and residents is that it's okay to change. Do not be afraid of change. I think I mentioned that at the PSA. My example of change was obviously changing from seeing patients day in and day out to going to be medical director at the health department. That was a change. People get locked into their career, and they may not be happy. They may be happier doing something else. It's okay to change, and don't be afraid of that. Change actually demonstrates courage, so you have to be courageous, and through my convictions, I've used courage. I've used courage to take chances as well.
[M]: That is awesome. Thank you so much for telling us a little bit about your story and some advice for us. I think a lot of people that are going to listen to this will be medical students. Do you have any further advice for us as we proceed through our medical career?
[Dr. R]: Once again, stick-to-it-ness. There will be times when it seems impossible, but it's not impossible. You got here, and you are meant to be here. So, you want to stick to it. The other thing I like to tell students is to have a folder—mine is called Positive Pats—where you put cards from patients or if you made an A on a test, you put that test in your folder so that when times get hard, you can look back and see the positive things that have happened in your journey. As far as being a medical student, being a resident, being a teacher, being a physician: Positive Pats.
[M]: I think that's a great idea. So that you can look back, on basically like your whole career, your life, and see and all of the positive things.
[Dr. R]: Only positive things are going to go in that folder, and you know, parents give you notes and give you cards, and those things should go in that folder too so you can remember the good times. When things get rough, you can remember the good times.
[M]: When did you start that?
[Dr. R]: I started that right after my residency. Yes, right after my residency. Sometimes I have to clean out the folder.
[M]: I was thinking how big is that box?
[Dr. R]: It is pretty big.
[M]: Well, thank you so much for being here with us today. I am sure that this is going to help a lot of people with the pieces of advice that you gave us and sharing your story with us. So, thank you!
[Dr. R]: Thank you for the interview.
An Interview with Danny Corbitt, M.D.
Madelyn Schmidt
The University of Texas Medical Branch–John Sealy School of Medicine
[Madelyn]: Joining me today is Dr. Danny Corbitt, an amazing gross anatomy professor. Thank you Dr. Corbitt for speaking with me today. Would you tell me a little bit about yourself?
[Dr. Corbitt]: I was born when the dinosaurs roamed the earth back in 1954. I went to school in the piney woods of Crockett, Texas. I graduated from high school in ‘72 and went to Texas A&M University from ‘72 to ‘75. I was accepted at UTMB Galveston in 1975. I studied there from 1975 to 1979. Then my residency program was in Fort Worth at John Peter Smith Hospital where I did a three-year internship for family practice and then switched to orthopedic surgery. This probably made me the longest tenured resident that John Peter Smith has ever had. I completed my orthopedic residency in 1985. I married Sally after my internship year in 1980. She stuck with me through all my residency years, and our first child was born in ‘84. I completed my residency in 1985 and moved to the Lewisville-Flower Mound Area. I have practiced for 32 years in orthopedic surgery, and I am now retired and teach part time at UTMB Galveston as you mentioned in the anatomy program, which has always been my dream. To teach anatomy to first year students is quite a wonderful experience for me. It's rewarding to see young people be able to “get it,” to see the light bulb go off.
[M]: I'm glad we can bring you some joy in all our struggles! Along your journey, you experienced and persevered through a life-altering cancer diagnosis. Could you share what the diagnosis was, and how that changed your perspective and treatment of patients?
[Dr. C]: I was diagnosed with adenocarcinoma which is non-small cell lung cancer in 2005. I ended up having a right upper lobectomy to remove the cancer and then chemotherapy. Survival rates have improved dramatically over the past few years for non-small cell adenocarcinoma, but it carried a very heavy mortality rate when I was diagnosed with stage 2B in 2005. Luckily it had not involved the pleura of the chest wall; it had remained in the lungs so that by doing the lobectomy I was cured. I didn't know at the time, but as years have passed it's obvious that I could not have been here, had it involved the chest wall and metastasized. Going through the diagnosis, the surgery, the chemotherapy, and recovery of that, really did change my practice. It changed my ability to deal with my patients because I understood what they were going through when I would see patients in my office with metastatic pathological fractures from cancer. It gave me a whole new empathy and sympathy for those patients. It changed everything for me. It was quite a traumatic experience.
[M]: I can only imagine. I'm sure your patients are grateful for that deeper connection that you were able to attain with them from it.
[Dr. C]: Yes, it brought them some comfort in the fact that I was sitting there in front of them, and I was a survivor. It gave them hope, and I think that's a lot of what we do as physicians is to give our patients hope. It helped give me a deeper understanding and it's what led to my retirement. I came to the conclusion, and I told my wife as soon as I could retire, I wanted to, and I wanted to start teaching. At that time, I didn't know how much time I had. It gave me a whole different perspective on life. I enjoy each day more from the standpoint of not knowing how many more I have left. It kind of changes everything.
[M]: Your oncologist had this mantra that encouraged you during that time. Would you share what it was, and how that impacted your fight?
[Dr. C]: She was actually my second oncologist. I had gone to a local colleague friend, and he was terrified to treat my cancer. And it became obvious in our meeting that he really didn't want to be there and so my wife and I talked about it, and we decided to go outside our local community and go to a different oncologist, Dr. Margie Sunderland. Oh, my heavens she was an angel. When we talked about the diagnosis and the prognosis, she was quite honest with me. She told me, “Dan, what do you want to do? Do you want to continue living? Or die?” And it had such an impact on me. I know a lot of times in medicine we back away, and we don't want to face what the facts are, but that had such an impact on both me and my wife. We don't know how many days we have and whether it's in a situation like mine where I was looking at a bleak prognosis of a cancer that has a history of six months to a year before it metastasizes and causes our death. Or whether I would be cured and have an unlimited lifestyle. We didn't know. Because of the unpredictability when she said that to me, I was taken aback that she would even say that. But she said it with a full compassionate heart. Her point was we can either look at life and we can choose to live in joy, or we can choose to live in the pits of depression. Why would you want to do that? How do you want to live with the days you have left? Do you want to live them in joy and happiness and live life to its fullest, or do you want to drudge around feeling sorry for yourself and have everybody around you depressed? It was a wonderful way to look at life, and I know it's blunt. But that was her point; you can choose either way you want to. That was one of the most wonderful things that she could have done for me, and I've thanked her many times since then for saying that.
[M]: It brings to light for physicians our job is not only to bring healing, but we're supposed to be a friend and be somebody near to our patients.
[Dr. C]: Absolutely we are. We are their only advocates sometimes, and we have to remember that.
[M]: Could you share some of the most difficult parts of being a physician?
[Dr. C]: I think the hardest part of being a physician is what Dr. Sunderland did with me. When you know what the natural course of pathologic processes are, and you deal with that with your patient. We invest part of our lives and our hearts into our patients and become their friend, become their advocate, become their best buddy. We suffer along with them. The hardest part of being a physician is bringing bad news to patients. It's the most difficult thing we do as a physician, but we have to, and we bring it with love, empathy, and sympathy. We have to be honest. We want to provide hope, but we can't provide false hope. The major thing about being a physician is honesty. Always be honest with your patients. Medical technology is growing exponentially, and it's wonderful. I have seen miraculous things happen in my lifetime, and I can only imagine what you guys will see in your careers. But it's still a personal thing. It is why medicine is an art based on science and not the other way around. I think it's very important that we have that connection with our patients.
[M]: As a successful physician and teacher, what has motivated you through those hard moments?
[Dr. C]: Probably the greatest motivation was my dad. My dad didn't finish high school. He owned an auto parts store in East Texas. He provided for his family and worked day and night. People would have car trouble in town, and they'd call him up in the middle of the night, and he'd get up, go to the store, and get parts they needed so they could get fixed up and on the road. I've seen him do that time and time again. And the thing he told me growing up was, “leave the world better than you found it.” As physicians, in any occupation that we are in, we can be kind, we can be generous, and we can leave things better than they began. And that has to be the driving force behind what we do. It's hard to remember sometimes, but we have to realize we're servants. We chose a profession of servitude. And it's hard. Sometimes our egos get in the way, but we must understand that we're here to serve society. We've been given a gift of being educated much higher than many other professions, so that we can understand and treat those folks. We have to remember that we're here to serve.
[M]: That's a great point and a very humbling reminder that's important for our entire career.
[Dr. C]: It comes back many times. There will be times that you will have accolades. You will be successful, achieve things, and be honored for it. But keep remembering to get up in the middle of the night when you need to and go take care of that patient. That's your reason for being here, and for me that was the driving force.
[M]: What advice would you give to rising medical professionals?
[Dr. C]: I think the biggest thing about being in medicine is perseverance. The practice of medicine is a marathon, not a sprint. We have to keep plugging every day. We're never going to know everything. There are going to be times when you're going to be exhausted. Take a deep breath and keep moving. There are times when I thought I wanted to quit. You’ll just want to give it up, and then you have to remember why you were placed here. Why were you chosen? Why were you picked to have this education, to have this position in society? Persevere. There's always tomorrow where the sun is going to rise, and we get to start all over again.
A Conversation About Academic Medicine and Going the Extra Mile
Brian P. Crowley, M.Ed. and Jonathan Giordano, D.O., M.S., M.Ed.
McGovern Medical School at UT Health Houston
Note from the author:
Dr. Giordano and I both hold Master’s Degrees in Education. As someone interested in academic medicine, I wanted to learn more about what that career might look like, since, as students, we only see the finished product of that work. I also wanted to talk about the shifts that emergency medicine has undergone since the pandemic. What changes did COVID-19 make that have become permanent? Is the specialty in a better or worse position since the pandemic? These are some of the questions I attempt to explore with Dr. Giordano.
[Brian]: I have Dr. Giordano with me. He is an emergency medicine physician associated with McGovern. I don’t want to butcher titles, so tell us a little bit about yourself.
[Dr. Giordano]: In terms of my roles at McGovern Medical School, I wear quite a few hats within the education sphere. Within our emergency medicine department, I serve as the director of undergraduate medical education where I oversee all of our clerkships and undergraduate clinical offerings. I also serve as the faculty mentor for our Emergency Medicine interest group and co-direct our Medical Education fellowship. Within the medical school I have two main roles: the first one as the assistant director of the Doctoring course, which covers the first eighteen months of the medical school curriculum. I also co-direct the acute care track in the fourth year — so, a lot of different hats, but all within the education sphere.
[B]: What is the career progression? I have to assume that when you got to UT you didn’t just pick those all up at once. How did that develop?
[Dr. G]: As time has gone on, more has been put on my plate, and I’ve asked for more as well. My career in education starts back in medical school. My medical school offered a program called the Academic Medicine Scholars program. We took courses about education theory, research methods, and then we also taught in different venues, and we got mentored guidance for lectures we gave the first- and second-year students. The benefit was they actually paid for the final half of my medical school. Throughout residency, I was involved with sort-of-different educational endeavors, where I tried to create curricula and really develop programs for our residents and our medical students who were rotating with us. My chief year gave me an even more in-depth look at how to help mold and create curricula over time and to deliver educational content. From there, I came down here to Houston, and my roles have expanded over time, but it has come with a lot of work. I just can’t see my career not being in academics – it’s everything I’ve always wanted to do in medicine. I get to deliver quality care to patients and take care of folks, while also educating the next generation or next group of physicians coming up behind me; and it’s something I really, really love. Our students and our residents that I work with are so brilliant and so inquisitive and so talented that they ask really good questions, and they want to know important details and the most current evidence. If I’m not keeping up to date with that, I can’t serve in my role, so it really pushes me as well.
[B]: It seems like there are so many upsides to teaching: you have to sharpen your own skills, you get to teach this group of highly motivated people. In your case, it even paid for half your education. What are some of the low points or most difficult aspects of being a physician educator?
[Dr. G]: Building curricula is interesting. How you approach it is interesting. I went back and did some extra schooling after medical school and got my Master’s of Education at [University of Houston]. Really learning the nuts and bolts of how to do that was excellent for me, but kind of eye-opening. There’s work involved there — and time. At least, personally, I try to put a lot of effort into that, and thought, into what I’m doing to create lectures or small group sessions or simulations or procedure labs – whatever I’m building – that are exciting, engaging, but most importantly valuable and at the correct level for my individual learners. Because your time is valuable as a student, and we want to make sure you’re getting the most out of these lessons, so I put a lot of time in on the back end to try and make them valuable.
[B]: Is all of that on the clock, per se, or does that leak into the personal time?
[Dr. G]: It depends on what you’re doing. Early on, a lot of your time is your time – it’s personal time – and once you create these niches, I feel like the institutional support typically comes. The total amount of time that you put into it is never fully supported. You’re always doing a little bit more work than what time you’re given or allotted is, but for me, it’s worth it because it’s what makes me happy. To be passionate about something and to enjoy something every day of your career, to me… I’m not sure that money or that little bit of time would make that big of a difference.
[B]: Am I correct that thinking early on in your career they want you to produce clinically, generate revenue, and then as your educational work gets recognized, people within the system are more willing to compensate you for that time?
[Dr. G]: I think it depends on where you work and what your specific role is. The ultimate goal is to be a really, really great clinician. So, I think that should always be our priority, to just take excellent care of patients. In terms of making that move into academia, it depends on where you work. Some places are more open to supporting you up front, others are more of a “prove that you need the time and then we will provide you the time.” And I think that’s all sort of just professional growth and conversations with your leadership in terms of job expectations. It is challenging for folks as they start out in academia, and I think it’s up to those individuals to have those conversations to see about how they can best be productive on both sides.
[B]: You’re not just an academician or a teacher, you’re also a clinician and a physician. There was this huge surge of support for healthcare workers when COVID [COVID-19] hit, and I feel like over the past two years you’ve seen that level of support decline as the level burnout increases. As someone who’s working in primary care, in emergency centers in one of the biggest cities in the US, what’s your experience been?
[Dr. G]: Over the last few years, there have definitely been challenges, clinically. Not just for me, but I think nationally. For me, in the ED, one of the big challenges that has really reared its head over the past few years has been ED boarding: where patients who need to be admitted are admitted... however, there’s no bed available upstairs for them to go to because the hospital is full. As we increase boarding in the ED, we eliminate locations where we can actually care for people who come to the ED because these admitted people are taking up beds in the ED instead of getting a bed upstairs.
[B]: Instead of getting a room upstairs, their room is one of the emergency bays?
[Dr. G]: And they wait there for hours and hours and days, sometimes, until they get a bed available upstairs. So, that has caused challenges for us. We don’t have as many care settings or areas where we can deliver care to patients, so we travel out to the waiting room and see patients in the waiting room, and it’s really challenging to do that.
[B]: Are you limited in what you can do? Can you do a full physical exam out there?
[Dr. G]: We try to be as complete and thorough as possible. We’ll bring folks into small rooms on the side and do our full histories, full exams, but once we see them, they sometimes have to go back into the waiting room to wait for results or to have testing done. It’s just not ideal. We’ve seen wait times go up. The “Left Without Being Seen” numbers throughout the country have gone up over the course of the last few years. So, the delivery of healthcare has been challenging. Some systems have been creative in trying to work around some of these challenges, and I think that’s what we need more of in healthcare, throughout the country. We need creativity and investment into how we can actually work around some of these challenges.
[B]: How does that affect you on a personal level in terms of fitting with how you pictured yourself practicing before the pandemic?
[Dr. G]: I think emergency physicians, in general, are trained to roll with the punches, be a little bit creative, and to work with limited resources because, oftentimes, that’s what we’re doing. So, I think our specialty has done a great job of doing all of those things. With that said, some days are more difficult than others, and it would be nice to have the space, staff, and see patients in private rooms. It’s just not the reality of the situation right now. We do the best we can with what we have, and I think that speaks to the resilience of physicians dealing with these challenges.
[B]: I feel like that has to be encouraging, right? What other positives have you seen come out of these situations?
[Dr. G]: I feel folks have really banded together. When the ER is blowing up and it’s really busy and there are patients everywhere, I feel like people come together. You see the best in people and the best in your colleagues. You really understand why they’re so excellent, and it’s really nice to see.
[B]: It’s almost morbidly beautiful in some ways, because if everything is routine, you’re going through the motions. When something shakes up your world like a snow globe, you really get to see what people are made of and what we can do. And you might never have experienced those relationships or those ties.
[Dr. G]: During the pandemic one of the most interesting things was we had a lot of travel nurses. These are nurses who are contracted and are coming in from everywhere, and these are folks you’re just meeting. They’re folks you don’t really know, right? They come in and they have these great attitudes and you’re all working together to try to just do the best that you can together. Those bonding moments are really wonderful. They really bring out the best in everyone. So, in the darkness there was some light, if that makes any sense.
[B]: Any closing thoughts you might want to give readers, about being an academician or an emergency physician — thoughts on what you would say to yourself if you were back in medical school?
[Dr. G]: I think that I have the best job in the world. I love what I do. Being able to work in emergency medicine, to me, is just… every day is so fascinating. I chose emergency medicine because I appreciated the undifferentiated patient. I wanted to be able to see a patient, think through what I thought was going on with them or what was wrong with them, and then come up with the diagnostics and the interventions that I thought were needed. I love the clinical aspect of my job. I think that there’s a large component of service to what I do. In emergency medicine, we see folks from all walks of life — insured, uninsured, we don’t say no to anyone. That, to me, is a special characteristic that I value. I’m able to take care of this, sort of broad, swath of individuals and hopefully make an impact on their lives and their health. And I think there’s something special about that. That clinical aspect, coupled with my ability to work with super-motivated, super-engaged learners… to me it’s the perfect job, and so I love what I do every day. I think that if you are entering academic medicine for those reasons, you’re going to have an incredible career.