What is your hometown?
I was born in Boulder, Colorado. My family moved around quite a bit (17 times before high school), starting in Colorado. Then from Minnesota to Iowa to Florida and back to Iowa. It has always been hard for me to answer the “hometown” questions.
How or when did you become interested in science and medicine?
I can trace my interest in science to a great teacher I had in high school. Mr. Brill was the 9th grade Biology teacher and he also taught an advanced class, which I took in 10th grade. He was the teacher who challenged me to not just coast through school, and during the process he really turned me on to the experimental dissection of nature by science. I had always been a questioning youth, who often was dissatisfied with the “just because” answers for why things were. To be taught that this was the pursuit of science was enough to capture my attention for subjects like Biology and Chemistry.
But, I cannot answer this question without relating a story that has followed me from my earliest memories. Back when adults used to ask children “what do you want to be when you grow up?” I was asked this question when I was five years old and I did not hesitate to say that I wanted to be an asthma doctor, like Dr. Codill (who was the doctor my family had traveled around the country to find). I was born with asthma but not diagnosed until I was four. I was misdiagnosed as having chronic bronchitis and many other ailments before an emergency room doctor in Georgia recognized the constellation of my symptoms. He referred me to Dr. Codill, who practiced out of a clinic in Des Moines. From that point on I was finally started on appropriate therapy and my family was given consistent advice that made sense.
Beyond just treating my asthma Dr. Codill made a lasting impression on me. The first time I met him he knelt down to look me in the eye and took my hand saying, “Let me teach you something, young man. When you shake someone’s hand, you grip it firmly and look them in the eye.” I always remembered this advice and it served me well. So, as you can imagine, when I first started thinking about going to medical school my parents where quick to point out the early influence that Dr. Codill had made on me.
How or why did you choose the UI to attend medical school?
After paying out of state tuition at Colorado State University for 5 years, I think there was a small part of me that figured I should take advantage of my “Iowa Residency,” which I was never certain exactly why I had held onto for so long. There is always an element of serendipity in the decisions I’ve made and pathways I’ve taken. I suppose they are obvious after the fact, but so rarely known before…part of the mystery of our life and conscious perception of the world.
The real answer for “why Iowa?” is in a small but tremendously important detail I discovered when I was applying to various medical schools around the country. Of course I applied to Iowa, as it was a top ranked program and it would be closer to my family (although those first few years I saw my parents less frequently than I had while I was in Colorado). But the detail that tipped the scales was how friendly and professional the administration and staff were with me during the application process. All potential medical students spend at least some time calling the programs they applied to in order to update their application or schedule their interview. I found that there was a significant difference in the helpfulness and attitude of the staff on the other end of the line. I decided to go to where the people were the friendliest and most willing to help me because I knew I was going to constantly be dealing with these people throughout my education.
As it has turned out I was right! At one point or another I have needed the guidance and expertise of each Office of Student Affairs and Curriculum staff member. Their friendly and caring assistance has contributed greatly to all of my success in medical school.
Is there a teacher, mentor or Carver College of Medicine faculty member who has helped shape your education?
My experience with medical school has been one of extremes. There have been classes that were exceptionally difficult for me, Biochemistry for example, and some that were so interesting that they hardly seemed like class at all. Similarly the third year was a roller coaster ride of experiences. I can honestly say that I liked every rotation so much I started to think that I could do it for my specialty. Each clerkship was a great learning experience. It also contributed to a fair amount of stress; wondering if I would ever find “the one” true calling, worrying that I would be disappointing the previous clerkship faculty for not considering my current rotation’s specialties, and being forced to leave my newfound interests to start anew with the next scheduled rotation.
Looking back I now know that all of that education was made possible by the faculty members that I worked with on each rotation. There was always at least one doctor who took me on as a learner and assumed the mentor role for the time they had me. From these people I learned more than just the medical management specific to their field, I got to see why these faculty members chose their career and what they liked best about it. This type of interaction gave me the proper yard stick against which to measure my own desires and perceptions. So, to answer the question, there have been countless mentors who have shaped my experiences and contributed to the well rounded education I now have.
What kinds of opportunities or advantages does being a medical student at Iowa provide? What about challenges?
Where to begin?! I think besides the advantages I’ve discussed above (multiple faculty mentors, great support staff, family connections, etc.) the types of advantages I can attribute to Iowa are immense. The University of Iowa Hospitals and Clinics is the hospital for the entire state! This cannot be true of too many other academic hospitals in the country. The State Papers Program requires that these patients get their care either here or in Des Moines, and that contributes greatly to the diversity of patients (and the variety of their conditions) than what you might otherwise expect from Iowa’s demographics. Also, Iowa medical students are able to rotate around the state for many of the main rotations (Pediatrics, Internal Medicine, Surgery, OB/GYN), and are actually required to leave the comfortable surroundings of the University of Iowa Hospitals and Clinics for their Ambulatory rotations (Family Practice, Outpatient Internal Medicine), which is a much needed “reality check” to see how health care is delivered in the non-university setting. Iowa, more than most states, still has a strong rural based economy with the last bastion of small town America and, subsequently, rural based practitioners (who, as far as I can tell, are the closest thing to the all around general practitioners of yesteryear). And finally, perhaps because of the two above mentioned points, there is a substantial culture of evidence based medicine in both the lecture curriculum and the clerkships here at Iowa. I have some added perspective in that I took a year away from coursework to get some basic science research via the Emory Warner Fellowship in the Department of Pathology. This experience, which is available only to Iowa medical students, was outstanding. It allowed me valuable hands-on exposure to bench work. What I didn’t realize at the time was how a year of reading research articles, attending basic science lectures and journal clubs, and designing my own experiments would serve me on the wards. There were no rotations in my third year where I did not apply these skills. Doctors of the future will more and more be subjected to conflicting and confusing research results, as well as new and advancing technologies that bridge the gap between basic science and medical treatments. I believe the opportunity to gain competence with medical research while still a medical student was a huge advantage and has already proven invaluable.
I honestly believe the biggest challenge to being a medical student here at Iowa will be getting out in the “real world” away from all the support and relative specialization of the academic environment. I’ve found, just in my few outside experiences, that there wasn’t the “consult” option to reflexively turn to when a complicated case came up. Similarly, with the emergence of the electronic medical record, Iowa has setup high expectations of what can (and should) be available electronically. The reality of not having years’ worth of imaging and lab results at your fingertips and worse, knowing that it can be done, will be a challenge for new graduates. But, I think this frustration we encounter will actually drive the expansion of the electronic medical record into everyday clinical and private practice.
Please describe your professional goals and interests.
After much thought, research, and speculation I've decided to apply to Family Practice programs and to the combined Family Practice/Psychiatry residency program at the University of Iowa Hospitals and Clinics (one of 6 in the country). Across the entire 3rd year I have liked practically every rotation. From Orthopedic Surgery to Radiology to Pediatrics to Psychiatry...on literally every rotation I have thought to myself that I could be happy doing that specialty. When I recently started my Outpatient Ambulatory Block (which consists of outpatient medicine from both an internal medicine and family practice perspective) I was excited by how many of my previous rotations were represented. I was evaluating orthopedic patients, suturing up punch biopsies, and counseling parents all in the same day.
Beyond that decision, which was difficult only because there isn't really a bad specialty to go into in medicine, I am very interested in Immunology as it has become a field of medicine unto itself; with contributions already made to oncology, infectious diseases, rheumatology, neurology and preventative medicine (i.e. vaccines). The year I spent doing research for the Department of Pathology I was learning a great deal from my mentor, Kevin Legge, Ph.D., who is an Immunologist by trade, and beginning to understand just how complex and adaptable our immune system is. I expect great advances to be made in our understanding and ability to develop new treatments (as well as know why old ones actually work!) in the span of my career.
What are some of your outside interests?
I probably should not admit to all my “outside interests” as that might distract from all the great advice and opinions above. I definitely believe that having interests beyond medicine has kept me grounded and able to see the bigger picture. In fact, I would argue that the outside interests give me better insight into my professional career.
As you walk down the main hallway of the Medical Education and Research Facility building you’ll find several of my photo mosaics on display. I have enjoyed combining two of my favorite loves; traveling and photography. The mosaics of photos taken in New Zealand, Hong Kong, New York, Boston, and Colorado have allowed me the opportunity to share some of my travel experiences as well as my impressions of these places.
Another interest that has blossomed during my time in medical school can be traced directly to the Iowa Writer’s Workshop. I didn’t mention it earlier in the “why Iowa” response but I should definitely acknowledge it now. The world famous Writer’s Workshop, which is a gem of the liberal arts college at the University of Iowa, has an office and permanent staff available for the health science graduate students. This resource was another distinguishing asset for me when comparing schools and has been more influential to my education than I would have predicted. The writing program has been a huge stress reliever for me and many of my friends. During the first two years we had monthly gatherings at a local pub in town to read and discuss our writing and poetry. Expressing ourselves in this medium brought out many great insights and has left me with pages of perspective I keep filed away under “Med School Memories.”
Do you participate in any community service/outreach projects?
If so, what are they and what have your experiences been? From the beginning of medical school, I have been a member of the Mobile Clinic, which is a student run clinic that provides medical care to the indigent community (at multiple locations in and around Iowa City). There are faculty who oversee and “sign off” on all of the exams and evaluations but most of the clinic, from obtaining vitals to checking cholesterol and blood sugars, is carried out by medical, physician assistant and nursing students. There are also dental and social work students who provide counseling and patient education as well, but the coordination and organization is done almost entirely by medical students.
The best part of the program for me now is to look back and see the progression that I went through and to see how it helped me integrate and practice the skills we were being taught throughout school. During my first years the older students were there to observe and coach us, which went a long way towards solidifying our general history and physical exam techniques. Now, in my fourth year, as the “older student” who gets to teach and encourage the new students, I can see how this experience is also part of the goal of Mobile Clinic. It is a great feeling to walk down the Medical Education and Research Facility hallway and recognize some of the first and second year students and to be someone they seek for advice about courses or about the challenges ahead. They don’t know it, but in teaching and helping them learn at the clinics I get to see how much I have learned in just a few short years. That’s the kind of reinforcement I need to keep up the pace and motivation in the “marathon” of medical school.
Mobile Clinic was also a great place to get some early experience working with faculty in a one-on-one fashion. Again, with the perspective of time I can see how this demystified those similar experiences on the wards and I believe it has helped me feel more comfortable presenting patients and developing an assessment and plan. Not to mention how in down times you often have the opportunity to discuss medicine and medical life topics with these accomplished faculty.
Do you have an insight or philosophy that guides you in your work?
Life is short, the world is wide, time is precious and money is not.
If you could change one thing about the world (or the world of medicine), what would it be? To treat obesity as a disease. No matter what side you come down on for the cause of the epidemic (genetics, high fat diet, high fructose corn syrup, etc.) it is clear that obesity will cripple the health care system in the years to come. I know it is an easy topic to pick out, but I honestly believe that there are real and reasonable treatments now available and the consequences of obesity are well known. Moreover, I have noticed how it is becoming common for patients to be seen routinely and treated for multiple other medical conditions while almost no emphasis is being placed on the patient’s weight as an issue that needs to be treated. I fear that stigmatizing the subject as taboo or as a “personal choice” is completely short sighted and undermines even the best intentions of physicians. For those doctors who say that their patients do not listen or refuse to change their ways, the recent studies of smoking cessation show that there is a direct correlation between the number of times the physician advises to quit and the success of patients in stopping smoking. I see little difference with this health epidemic. The entire world has stood back as America has gotten fatter and fatter and it is time that the medical community takes the lead in addressing the problem.
What one piece of advice you would give to students who are interested in applying to medical school?
If you want to go to medical school you need to take the following pieces of advice into consideration: Do not give up if you do not get in on the first try; whether that is the first time you apply, or the first time you take the MCAT. Second, if you want to be a doctor because of the money, think twice. There are plenty of jobs that take less than 8-10 years of training before you start making “big bucks”. And third, plenty of people are “smart enough” to be doctors, and plenty of people are compassionate and caring enough, but the kind of doctors the world needs are the ones who are enough of both.
What do you see as "the future" of medicine?
I see the future of medicine as it is defined by the present. Presently there are too many specialists treating specific diseases and not enough generalists providing preventative medicine. Sure, this gives the United States a clear advantage when it comes to putting great minds to work at the extremes of medical understanding and treatment of disease. We continue to refine and expand our knowledge of cancers and genetic disorders but we have under emphasized so many of the basic necessities of health; nutrition, exercise and mental health (a.k.a. happiness). I see medicine relying more and more on para-professionals (Physician Assistants, Nurse Practitioners) to deliver this “primary care” and the physicians will be increasingly pushed towards supervision and administration.
I am uncertain of what direction the future will take; I believe there will almost have to be a reform of some kind, as our current system is clearly unsustainable. Ideally we will go the route of other western nations and expand our development of primary care physicians, as they continue to be the most cost effective form for delivering health care. This will take a significant change of course for the nation, but to that end Iowa may be a leader. It seems to me that the University of Iowa Carver College of Medicine has developed a curriculum whereby specialists provide the bulk of the education and training and thereby simultaneously produce medical students who have been broadly educated and introduced to a maximum variety of specialties. This way if the majority of students enter primary care (Family Practice, Internal Medicine, and Pediatrics) they will have a great knowledge base from which to approach their patients. The system breaks down when more specialists are produced than generalists, and unfortunately for many reasons (first of which is probably the higher reimbursement of specialists) this is exactly what has been happening. In the future, this trend must be addressed.
Although I welcome a more socialized form of health care, which is to say an expansion of the current Medicare and Medicaid to all Americans, I personally think there will always be a two-tiered system and those who can afford retail priced medicine will continue to get the same level of top quality care that the United States has always provided. In my travels I have seen first hand the delivery of socialized medicine and I would argue with those that think it will bring long waits and diminished care. They haven’t seen how our current system deals with those who have no insurance and/or money. What it will bring is another layer of oversight and therefore a potential for corruption when it comes to what treatments are “standard of care”, but the public’s awareness and the physician’s diligence have always been the only safeguards against these pitfalls. Besides, currently there is this type of oversight already taking place in the form of what insurance will and will not reimburse. The only difference is that presently it is the patients and the physicians who must navigate these private bureaucracies rather than trained health care administrators.