It’s been a while

Hello friends. It’s been quite a long time since we’ve communicated. Life has been busy -- nearly finishing family medicine residency, getting engaged, planning a wedding, COVID cancelling that wedding, planning another wedding, applying to fellowship. Lots to reflect upon on the last few years. 

Just wanted to give you a heads up that I’m trying to consolidate my online presence, and will post here, but my HQ will be at www.roheet.com. 

Thanks!

Medical School Admissions

Hey Medblr,

As AMCAS/AACOMAS season ramps up, I just wanted to remind you of a great resource for premeds who are applying to medical school! 

It’s called Lean On, and it’s essentially a rocket-powered medical school admissions tool that I’m hoping more premeds take advantage of! 

Lean On uses your individualized data and runs it through a proprietary algorithmic engine, which analyzes it across 50 different dimensions of comparison to find your ideal medical school student adviser. It’s essentially a successful future version of yourself telling you how to get where you want to be! And it’s been working; 95% of folks who use Lean On get into med school!

For a small fee that goes towards fighting medical student debt, you get your personal statement, activities descriptions, or secondary application reviewed and edited by a medical student just like you. If you need advice on interviews, there is help for that too!

I started Lean On after experiencing generic advice from my premed counselors and being actively discouraged from applying! I thought that was wrong and, after seeing how all my medical school classmates broke the typical premed mold, I knew there could be something better. Thus, Lean On.

I hope you check it out! www.leanonadmit.com

Getting Into Med School

Spring time is here. While for most folks that means getting outside, for premeds, that means getting their medical school application together. I remember when I was applying, the sheer stress of cobbling together all the disparate pieces of information - let alone writing a good personal statement, nailing some awesome letters of recommendation, and strategizing properly - was daunting. It weighed heavy. 

There are a ton of awesome resources online to help with medical school admissions. A lot of Medblr bloggers are also on top of doling good advice. For those of you applying right now, my general rules of thumb are :

1) Stay away from the often emotionally toxic land of SDN. All it gave me was anxiety. This is not a good time to hang out with your premed friends. And if there are rumors about applications and medical schools, don’t listen to them. Go straight to AAMC or the AMCAS website and figure it out for yourself firsthand. 

2) Ask everyone to proof read your personal statement. And, on top of that, CARE about your personal statement. It is what makes you shine as a person and differentiates your application. Just because you have a 4.0 GPA and a stellar MCAT score does not make you a worthwhile candidate, especially with holistic admissions processes that medical schools are employing. 

3) Don’t be afraid to get help. It’s why I started LeanOn, the intelligent admissions service that pairs you up with a medical student just like you using 50 different data points to optimize your mentorship experience. Check it out. 100% of users would recommend it to a friend, and you might too.

4) Take a step back. In the rush of organizing your documents, it’s important to understand why you’re doing this. After all, medical school is no joke. Your motivation should tie everything together and is ultimately what makes you compelling as an applicant.

I know I haven’t been blogging a lot lately (thanks residency), but I’m still around lurking in the medblr scene. Feel free to message me at any point with questions!

I Don’t Know

The volume of modern medical knowledge is staggering and has soared at a seemingly logarithmic pace over the decades. As a developing primary care physician, I am, ideally, expected to understand and manage 80% of it.

This is undeniably daunting. I often find myself at a loss of words for my patients' more nuanced questions, often falling back on basic pathophysiology, with broad explanations of management, to aid our mutual understanding of a condition. Each time, however, I am dizzied by the depths of knowledge I cannot fathom.

And I share this with my patients. The amount of times I have answered, "I don't know." seems borderline silly. A doctor who does not know seems culturally counter-intuitive and even damaging to ones image. Yet, my patients seem to welcome that honesty and vulnerability. It re-frames the appointment as a shared journey, a practice, of health and health care, instead of a mysterious one-stop shop for answers. Finding the knowledge may be as simple as deferring to my attending physician or as involved as scouring the latest AAFP, NEJM, Dynamed, or UpToDate on the bedside computer together.

My patients seem to appreciate this, as they thank me for my time and return to see me and my team. Perhaps it humanizes the appointment, removes the doctor from the academic pedestal, and engages them more in their health than they otherwise would have been. I anticipate that with the upcoming years, the frequency with which I say, "I don't know." will diminish. Until then, however, I'll continue answering, "I don't know, but let's find out."

(originally posted on roheet.com)

A Pledge in Divisive Times

As Donald Trump begins his presidential tenure, founded upon objectively sexist, racist, bigoted, xenophobic, divisive, and otherwise hateful campaign rhetoric, I will be entering my medical residency, a critically formative time in any young physician’s career. With the impending threat of yet another tumultuous transformation in health care, let alone society itself, I wish to reaffirm the following to my future patients during these divisive times:

1) I will care for you to the best of my ability, regardless of your race, religion, creed, ethnicity, nationality, political ideology, gender, sexual orientation, or background. 

2) I will strive to create a safe and healing environment for you, free from prejudice or persecution, in which you will be free to be yourself.

3) I will strive to be a better advocate on your behalf and ensure that you are a priority in whatever position of authority I may find myself in.

4) I will strive to help empower you, so that you may be better engaged in your health and health care. 

5) I will strive to always be learning, so that my counsel as your physician is always rooted in the best available scientific evidence.

I promise to do these things to the best of my ability and knowledge, both of which will augment and adapt with time, experience, and exposure. 

Want to change medical education? Want to be amongst leaders doing the same? Hope to learn from creative thinkers breaking the rules about educational design, learning methods, and student life? 

Have an idea of how medical education can change? Perhaps you have some project, abstract, or paper that details a better way of learning or teaching? 

Come to Stanford Medicine X | Ed in 2017!

Read. Apply. Change education. 

Nothing

Originally posted here

It was the first time I had ever heard nothing – the pin drop silence of stillness.

It was the first time I had ever felt cold – a cold that makes you want to wrap up in sweaters.

It was the first time I had witnessed an entire body reduced to a solitary purpose.

It was the first time I had witnessed someone slowly and inevitably die in front of me.

I sat in front of him as he died. Everyone knew he would, it was just a matter of time. An infection ate away at his lungs, but it was too late to do anything about it*. He chose not to be intubated but wanted treatment, so the best we could do is force breaths into his airway through a mask.

Yesterday, he could talk. Today, he could not. Yesterday, he said he wanted to see his friend, Chip*, who was now en route. Today, he was slumped in his gurney and could not respond to his name or even pain.

I sat next to him as he died. Every breath he mustered was a monumental Sisyphean task. His oxygen saturation, a measure of how concentrated blood is with oxygen, dipped between breaths. His body was gasping for air and it was tired of doing so. Medications flowed through his IV line to make him as comfortable as possible. His lifespan was measured in minutes.

Sitting in a chair next to his bed, I held his hand. It was deathly cold and unmoving. His body had clamped down its peripheral blood vessels to preserve cardiac and neural blood flow. If his lungs gave out, his entire body would be starved of oxygen, and his heart would shut down, quickly followed by his brain. His life hinged on a mask delivering volumes of air anytime he attempted to breathe in.

I sat with him as he died. I barely knew him, having assumed some responsibility over his care just two days prior. I filled in the details of his life through his diagnoses; chronic hepatitis C, history of IV drug abuse, schizophrenia, lives alone with his cat, has no friends save for Chip. It sounded rough and isolating. His oxygen saturation dipped lower. The minutes were ticking.

My eyes watered as I watched a man, once thriving, reduced to a simple ventilation mechanism. Memories of my grandfather dying, a death I was absent for, flooded me. I cried on the floor the night I had heard, curled up in a ball, as my grandfather withered 8,000 miles away. It had been years since, but it felt like yesterday in mortality’s presence. It hurt.

It felt selfish to cry in front of this dying man whom I barely knew. It felt like I was using his death as a version of perverted self-therapy. I collected myself and started talking to him about things I thought he might like – the fall was turning trees red, the Portland Timbers aren’t performing so well, that Chip was on his way. God, Chip, please come soon. I was holding death's hand and telling it stories.

Chip arrived two hours later. Miraculously, the patient was still breathing. I offered Chip my seat and quickly stood outside the room, closing the windowed doors as I did. Since Chip would matter more than I ever would, I had little right to be in that room. I stood outside watching Chip say his last words. He would pull out his phone and show him photos. His friend would heave his entire chest in response.

Ten minutes later, he stopped breathing. He had waited until he could see Chip one last time before giving in. Chip looked at me, back to his friend, then back to me.

I nodded. Chip cried.

We went in to do a final exam.

It was the first time I had ever heard nothing when I expected a heart beat.

It was the first time I had ever felt cold when I expected warmth.

It was the first time I had witnessed a being reduced to biology.

It was the first time I had witnessed someone slowly and inevitably die in front of me, and, yet, somehow, hang on until just the right time.

*Names, circumstances, and other identifying details have been altered to preserve patient privacy.

Whenever my patients asked me if vaping was safer than smoking, I’d say, “We don’t know yet. In my opinion, I can imagine that inhaling any kind of smoke would still cause inflammatory changes in your lung tissue that would predispose you to cancer. Science doesn’t know the exact mechanism or how frequently it happens, but I’m sure it one day will.”

One day has come. The chemicals and copper contained within vaping aerosols has been shown to cause genotoxic and mitotoxic effects on lung cells. Check out the link to learn more.

I want to emphasize that this isn't necessarily proof that vaping will absolutely cause cancer. It's evidence that it raises the chance of deleterious cellular effects, which make cancer more likely. Vaping is still new and science is still studying it, but this piece of research isn't encouraging for vaping enthusiasts.

An incredibly smart approach to forcing innovation in an oligarchy of hospital IT software. Instead of focusing on big name hospitals, AthenaHealth is getting the community on its side by evangelizing its products to smaller hospitals. Even more importantly, instead of charging a huge upfront installation and maintenance bill, it takes a share of revenue that the hospital generates using its EHR. That sends a powerful message – your success is our success, we’re in this together. That’s a definite way of creating a more innovative and adaptable culture in a traditionally stagnant field of hospital software. 

The White House Workshop

“Look around you,” he encouraged, “We are in a room that has been used to negotiate international treaties…and now there are sticky notes on the wall!”

Everyone burst out laughing and applauded. In front of us, delivering some opening remarks, was DJ Patil, Chief Data Scientist of the USA. In this room, Stanford Medicine X and the White House Office of Science and Technology Policy had convened some of the most powerful and influential names in medicine, technology, patient advocacy, and politics to solve one problem – engaging patients more broadly and rigorously in the research process. I remembered my invite, “The Stanford Medicine X and White House joint event on Engaging Participants as Partners in Research.” I was thrilled.

(DJ Patil speaking. Photo from Stanford Medicine X Flickr account)

And the kicker? No one knew who anybody else was. In clever fashion, the guest list was kept secret, the agenda was sealed, and everyone’s name tags had no mention of their titles. Why? To generate a more equal playing field, where all participants were valued, irrespective of their title, hierarchy was nonexistent, and everyone came from a place of naivety – the birth place of creativity. A blank sheet with all the potential. Stanford Medicine X calls this their Everyone Included framework. 

Brilliant. 

(Workshop conversations. Photo from Stanford Medicine X Flickr account)

For the next six hours, we used IDEO design principles to hash out our ideas, moving from room to room among the White House offices. I chuckled in disbelief as I passed “National Security Council” chambers to get to our small group rooms. At the end of the half-day, we had generated six different ideas that could propel patient engagement forward in the world of research. Workshop participants enrolled for the ideas they thought could contribute to. 

At that moment, I figured the workshop was over, but a most remarkable event happened. Two sheets of paper went up on the wall, one titled “Needs” and the other “Offers”. Slowly but surely, participants in the workshop introduced themselves, their titles, their expertise, and then generously offered their time to aid everyone else in the room. As it turned out, I was sitting down next to CEOs, CROs, CTOs, Editors-in-Chiefs, founders, advocates, and other incredibly accomplished and influential individuals.

I raised my hand and offered, “My name is Roheet Kakaday. I’m a 3rd year medical student. If anybody has any project that may even remotely impact the next generation of physician or would like a student’s perspective on their project, I would be more than happy to help.” My name and offer were written on the sheet, alongside all the many other individuals who volunteered.

After a while longer, we disbanded. Business cards were exchanged. Keep-in-touch’s and goodbyes wished. A transformation happened at this workshop – we formed a tribe of progressives indelibly tethered by our collective link to the White House and to the spirit of Medicine X. 

Later that night, I stood in front of the White House to just soak in the moment. I was incredibly thankful for the community I had found and the changes we were engendering. Dr. Larry Chu, founder of Medicine X, had such a powerful vision that has attracted a following of some of the most visionary people I had ever met. During the workshop, one of attendees quite simply said to me, “We are from the future. It’s as simple as that.” And, now, with the backing of President Obama’s Precision Medicine Initiative and the White House Office of Science and Technology Policy, we are more motivated than ever. 

I can confidently say that we look forward to the changes this workshop heralds. 

(My general reaction during this entire experience.)

Recently, I was invited to the White House in what may be one of the biggest highlights of my life. I’m incredibly humbled and thankful for the support that allowed me this opportunity.

While at the White House, I’ll be participating in a workshop, co-hosted by Stanford Medicine X, on engaging participants as partners in research, a core principle of President Obama’s Precision Medicine Initiative. The event is designed to identify what’s working in research, strengthen the community of innovators in this space, and accelerate progress of patient engagement in research. 

To be frank, I’m pumped. Some of the biggest names in medicine and politics will be discussing how we can sustain innovation and progressive thinking in medicine. If you have any questions, comments, or concerns regarding patients’ involvement in research or medicine more generally, let me know! 

Undergrad, graduate school, professional school? Doesn’t matter. Design student, med student, philosophy of art graduate, pharmacy student, nursing undergrad, astrophysics major? Doesn’t matter. You are anyone and from anywhere and are learning anything. 

What matters is you are passionate about people and their health.

Medicine X is the multidisciplinary conference for you. Thinkers, doers, students, teachers -- we’re all here. We’re all learning. We’re all sharing. 

You + Stanford + Medicine = Amazing. 

Make it happen. Apply to the Student Leadership Program today -- it’s a unique scholarship program where you’ll get to collaborate with the brightest minds in and around health care to focus on innovative solutions, all on Stanford’s amazing campus in sunny California. All expenses paid. 

Application deadline is soon! Absolutely everyone is invited. Get the word out!