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Learning to Choose Wisely

In January of 2018, then-M1s James Haggerty-Skeans and I escaped the cold Michigan winter for Austin, Texas as part of a new US Medical School initiative — Choosing Wisely STARS. Having already taken Canada by storm, Dell Medical School spearheaded the US campaign, inviting two M1s from 20 medical schools across the country to discuss the importance of value and resource stewardship in medicine.

M2s James Haggerty-Skeans and Katherine Wolf meet with their mentor Dr. Micheal Heung and the American Board of Internal Medicine Foundation Executive President and COO Daniel Wolfson

After surviving an unnecessarily eventful evening of travel that involved an unexpected detour to Chicago, a pair of lost shoes, and a minor run-in with security who tried to confiscate my tuning forks, James and I were ready to meet our cohort and get to work.

Throughout the following two days we uncovered the history of the Choosing Wisely Campaign, which was initially launched in 2012 by the American Board of Internal Medicine Foundation. Based on a 2010 article in the New England Journal of Medicine by Dr. Howard Brody, the campaign focuses on encouraging medical sub-specialties to identify five tests or treatments from their specific field that are overused and offer limited benefit to the patient. Since the initial nine publications, more than 80 societies have joined the initiative and published their recommendations.

James and I were subsequently tasked with bringing this national campaign to UMMS. Although perhaps more challenging than our other options, we were excited by the idea of systemic curricular change and sought the help of our faculty adviser, Dr. Michael Heung, to lead us in our endeavor. In our quest for space within the curriculum to emphasize this topic, we quickly found an ally in Dr. Jennifer N. Stojan, director of the Doctoring course. Over the past several months, our team has worked to construct an M4 Doctoring Session, which will launch in March of 2019, and will cover US health care expenditures, the impact of cost on patients, and how they will be able to reduce waste in their own practice.

As James and I transition into our lives as newly minted clinical students, we are lucky to have added two M1s to our team as they prepare to fly to Austin for what we hope will be the second of many Choosing Wisely cohorts from UMMS. While resource stewardship was not a passion of mine prior to medical school, I look back on the impact it made throughout my first year and am confident this experience will influence my clinical decision making, patient interactions and research interests both in the remainder of my education and in my future practice.

Physicians Connected

I struggled with severe depression and suicidal ideation during my second year of medical school. Depression robbed me of the things I value most – my intellectual curiosity, my motivation to help others, and my will to live. I had come to Michigan armed with a genuine love of science and an earnest desire to do good, but there was a miserable period of time when I lost touch with both. I spiraled. I started to perceive myself as negligent, unlovable, a failure. Thankfully, a member of the medical school administration recognized how much I was struggling, and connected me with lifesaving mental health resources. With the school’s support, I took time off. I worked with a psychiatrist. I took medication. Gradually, over the course of many months, I recovered. I became curious and motivated again. Overcoming depression was unequivocally the hardest thing that I have ever done.

Hanging out with one of my best friends in medical school, Jasmyne Jackson, after the ‘Out of the Darkness’ walk put on by the American Foundation for Suicide Prevention.

Since getting better, I have become passionate about diminishing mental health stigma, publishing my personal narrative and producing a short film about depression with contributions from over thirty students, residents, and faculty at Michigan Medicine. I founded the grassroots initiative, ‘Physicians Connected,’ in the hopes that more medical trainees who need help will not be afraid to ask for it. I have worked to bring more attention to the issue of physician mental health through interviews with the E.W. Scripps news company and with NPR (airing soon on Michigan Radio’s Stateside!).

Primarily because of the energy and enthusiasm that abounds at Michigan, my advocacy efforts have taken on a life of their own that I could never have anticipated. On September 29, 2018, Physicians Connected participated in an ‘Out of the Darkness’ walk, put on by the American Foundation for Suicide Prevention (AFSP). Our team of medical students and attending physicians joined the citizens of Ann Arbor in a walk around the city in an effort to combat mental health stigma and raise awareness about depression and suicide. In the two weeks preceding the walk, we raised over $3000 to support AFSP’s important initiatives, which are all focused on preventing suicide and supporting those affected by suicide. At the walk’s start, we were joined by Debbie Dingell, U.S. Representative for Michigan’s 12th congressional district since 2015. Congresswoman Dingell (bottom left in the group shot below) gave a moving speech about losing her own sister to suicide, and emphasized the importance of the physician voice in changing the way that mental illness is conceptualized. It was a truly beautiful day!

The Physicians Connected team (comprised of medical students, residents, and attending faculty from Michigan Medicine) at the ‘Out of the Darkness’ walk, put on by the American Foundation for Suicide Prevention!

I felt so alone when I was depressed, and so ashamed. But since sharing my own story, I have received hundreds of letters from physicians and medical students from around the world, empathizing with my struggle. I have learned that depression is an epidemic in the physician and physician trainee populations, and that as is the case with any epidemic, committed people are needed to put up a fight. Somehow, a great passion has developed out of my darkest hour – one that lends strength and meaning to my personal and professional identities. I have truly never felt more in touch with my motivation to help others, or more excited to be a doctor. As I express in my essay, ‘I Solemnly Share,’ “If I have learned anything after spending most of my short life in pursuit of academic distinction, it is that the appeal of the dividends – good grades, high praise, awards – is as ephemeral as the warm glow felt on their receipt. Not so with the call to protect human life; that’s something truly worth living for.”

Ann Arbor Delonis Clinic

It has been a dream of mine to attend the University of Michigan Medical School since I was very young. This is partly because I have always been a huge Michigan football fan, but more importantly because of the tremendous amount of opportunities Michigan offers to help people who are financially disadvantaged. Coming from poverty, I have always wanted to give back to this community to hopefully give them a chance at following their dreams, as my mentors have done for me. I took advantage of one of these opportunities last week by volunteering at the Delonis Clinic in downtown Ann Arbor, and wanted to share this experience with you.

To begin, the Delonis Center is a homeless shelter that started in 2004 with the goal of providing homeless people in Ann Arbor and surrounding areas free housing while they help them get back on their feet, find a job, and find permanent housing. The Delonis Clinic, where I volunteered, is the medical center inside of this building. It resembles a small urgent care facility, but the impact it has had on the greater Ann Arbor area is extensive. Anyone who meets a certain financial need is eligible to either make an appointment at the clinic or stop in during business hours to be seen for a variety of ailments. This has been a blessing for the people who have used the service.

I can relate to this personally as I have lived most of my life without health insurance. The stress of deciding what is “urgent enough” to go see a doctor is something I hope none of you have to experience. Considering almost all of the patients the clinic sees are also homeless, one can see the difficulty these people experience when trying to manage their health. The fact that Ann Arbor has a place in the Delonis Clinic where they can effectively treat this population is something that makes it a very special place to me.

The role of the medical student at the Delonis Clinic is also very rewarding. As an M1 you are paired up with a senior medical student (usually M3 or M4) and a family care physician. The M1’s role is to greet the patient, take their vitals, then spend about 20 minutes taking their medical history and doing a relevant physical exam for whatever brought them to the clinic. The M1 will then present these to the attending doctor, go over a possible treatment plan for that patient, and then see the patient with the doctor to explain their options to try and find a patient-centered solution to their concerns.

This experience is priceless. For me, much of the first year of medical school has been trying to figure out how to tie in the massive amount of information we are learning into actual clinical care. Being able to volunteer at the Delonis Clinic gave me a low-stress experience to help me answer some of those questions and serve a population that is less fortunate than myself. Having this type of opportunity is something I believe makes the University of Michigan Medical School a special place to train.

My “First” Tag Days

I’ve never liked walking around outside in the cold, even if I did grow up in Ann Arbor, Michigan. I therefore never quite understood why my parents would bundle my twin brother and me up to walk around downtown Ann Arbor late at night the first weekend of December every year as a kid. Even though I had to succumb to the frigid temperatures and be dragged in and out of stores participating in the annual Midnight Madness sales, there was one thing I remember loving about that tradition: collecting all of the colored tags from the University of Michigan Medical School students around town. I didn’t really get why there were “grown ups” dressed up in funny costumes and red capes around town exchanging dollars for colorful tags, but I never really questioned it.

Tag Days has always been important to my family (see picture of my old dog, Hunter, with tags on his collar in 1998). My mom was a Galens member when she was in medical school at U of M. Since becoming a faculty member, she has been a Happy Van driver countless times, distributing hot chocolate and snacks to cold, hungry taggers around town. My dad recalls that one of his favorite Tag Days memories was when he would walk my brother and I around from corner to corner trying to find my mom’s van so we could see her and say hi. Growing up, Tag Days brought my family and the local community together as we’d celebrate in downtown Ann Arbor each year. And so, my love and appreciation for Tag Days started to bud far before I understood the full extent of what Tag Days means.

Fast forward to December 2, 2017. I woke up on what seemed to be the most important day of my life—the day I interviewed at the University of Michigan Medical School. Before I walked out of the door in the morning, my mom flagged me down and reminded me to grab a couple of bucks so that I could donate to the students spread throughout the hospital and receive a tag, which I proudly wore on my coat for the rest of winter. Less than a year later, I am now a student at UMMS with the first weekend of December fast approaching. Over this year, I have learned that the funds raised through Tag Days go to local organizations in Washtenaw County that work with underserved kids. I’ve also learned about all about the logistics of planning such a large event, and have eagerly helped fold tags in the student lounge as a late-night study break. Now that I’m finally starting to understand what Tag Days is about, I can’t help but feel honored to be a part of a tradition that I grew up with, and which means so much more to me now. For me, Tag Days is about bringing together and supporting community, as it brings Washtenaw County and Michigan Medicine together in the most beautiful way. I am so excited for my “first” Tag Days as an M1 and to be able to bring together and give back to the community that I grew up in.



Representing medical students to the House of Medicine

At first glance, it may not seem that increased access to identification cards for homeless individuals, front-of-packaging labels on food products, and accountability in reporting for Medicaid waiver projects have much in common. But all are topics of new policies passed at the November American Medical Association (AMA) Interim Meeting that came from student action! In fact, of the 13 items that the medical student section brought to the House, ALL were passed. 

This year, I’ve had the privilege of serving as a Delegate to the AMA. Thinking back to my first AMA meeting, I’ve since learned a tremendous amount about how policy is crafted and implemented. Especially during this Thanksgiving week, I’m thankful to serve as a voice for what medical students find important, especially on policies designed to protect the most vulnerable among the patients we serve.

My stellar policy analysis team for this meeting

One of the things I’ve appreciated most about my time with the AMA is the new friendships with students and physicians from around the country. For this meeting, I had the opportunity to serve as the Delegate lead for reference committee review, and I really enjoyed mentoring students who were new to the process. Much of our work happens in advance of the meeting, including in-depth policy review, providing feedback to student authors of resolutions, and conference calls to determine the medical student section stance on all resolutions and reports. I love having the chance to get to know team members personally after collaborating with them virtually for weeks!

Michigan delegation members in the House of Delegates

As a dual-degree student pursuing an MBA this year, I was also able to apply my new skills and knowledge when thinking through the economic implications of proposed policies. I’m glad to have this flexibility at Michigan to pursue these additional interests and learn more about our health care system through a broader lens.

I’m looking forward to the holiday season, time for reflection this Thanksgiving, and re-connecting with Medical School classmates through Friendsgiving and Tag Days. 

When Words Fail, Music Speaks

Music has always been a core piece of my life. I attended an arts elementary school where I learned to play the piano and started to sing. I have sung in choirs and show choirs, musicals, a cappella groups and weddings. I taught myself to play the guitar, ukulele, and most recently have tried my hand(s) at the violin. Needless to say, it is a huge part of my identity.

For me, music has been a form of self-expression and the best kind of therapy. A perfect afternoon was always sitting on my bed with my guitar, getting lost in a song. A perfect night was much the same, but in a coffee shop in front of a small crowd from my hometown. The music brought me peace.

Despite participating in a cappella and musical theater during my years as an undergraduate student, I felt disconnected from music. I lost a sense of what music meant to me. I needed to feel the music again, and I was determined to rekindle that passion in medical school. My mental well-being depended on it.

About a week into my M1 year, I received an email from the Medical Arts Program Artists’ Guild (MAPAG) about their upcoming showcase. They were calling for performers of all kinds (singers, instrumentalists, rappers, poets, storytellers, etc.) to come showcase their passions. I thought back to my years in high school singing in small coffee shops and decided to give it a go. I filled out the interest form (it was that easy) and began practicing.

The showcase took place on a warm evening in late September. I showed up early (as I always do) and tuned my guitar. I could feel my heart in my throat. Has it really been that long since I’ve played like this? I began my soundcheck and quickly realized that oh man, I should have brought my acoustic electric guitar but I just like this guitar better okay and I guess it’s good that you can hardly hear it because I keep messing up I am so nervous! Then Kevin, my fellow M1 and guitar ROCKSTAR, offered me use of his guitar. It was the exact same as mine, but could be plugged in so people could actually hear it. I hesitantly agreed…

My friends and classmates began to fill the seats. I helped myself to a plate of cookies to calm my nerves. Then, the show began. I wish I could say it went off without a hitch but, honestly, I messed up! And so did other people! And it was okay, because it was fun. Being up on the stage in front of a small crowd, just me and my guitar, made me feel things I haven’t felt in a long time.

Fall 2018 MAPAG Showcase

The talent in the room was unbelievable. It was humbling. It is easy to see your fellow medical students and think about how smart they are, but the reality is that there is so much more to each of them than being a medical student. For us musicians, MAPAG gave us an opportunity to engage in that part of our lives, to celebrate that part of ourselves, and to remember why we love music. That night reminded me that music is a way in which I can connect with emotions that I otherwise leave unspoken. When words fail, music speaks.

Of course, it takes more than one amazing night to reconnect with a lost love, but I am well on my way.