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Physician Spotlight: Oakstone Course Director, Dr. Martin A. Samuels, Honored With Johns Hopkins Clinical Excellence Award

Dr. Martin SamuelsUnselfish regard for or devotion to the welfare of others. That is how the dictionary defines altruism. At its purest core, that is what compromises the heart of great physicians. Oakstone is proud to partner with many physicians who fit this description, and today we honor Dr. Martin A. Samuels for his service and recognize his recent honors from Johns Hopkins, Williams College and The University of Cincinnati.

Dr. Martin A. Samuels, MD, FAAN, MACP, FRCP, DSci (hon.), founding chair emeritus of the Department of Neurology at the Brigham and Women’s Hospital and the Miriam Sydney Joseph Distinguished Professor of Neurology at Harvard Medical School recently was awarded the inaugural National Clinical Excellence Award from Johns Hopkins University. Dr. Samuels was the only recipient in the country including all specialties. Dr. Samuels was  also recently awarded a Bicentennial Medal by his alma mater, Williams College, where he delivered the Convocation Address (can be viewed on YouTube). He was also awarded the Distinguished Alumni Award, representing his medical alma mater, the University of Cincinnati College of Medicine. 

It’s clear these achievements are rooted in a deep and impressive track record that includes establishing subspecialty areas in neurological medicine — such as neuro-cardiology, neuro-hematology, and neuro-gastroenterology — but at the same time, as one gets to know Dr. Samuels you could almost expect it. Why do I say that? Simple, making one’s way through hard work and caring is what he’s all about.

“I wanted to be an academic physician but wanted to do it from the vantage point of a clinician. The system was not amenable to this goal. I just worked at my vision of an academic clinical neurologist and over many years the system caught up to my vision. Hard work and high standards were the secret,” says Dr. Samuels.

The other aspect of that vision is what Dr. Samuels considers the lynchpin. “Altruism is the key feature of a professional in any field, but is most important in physicians. There is too much inward focused thinking and not enough effort on outwardly focused activities.”

It’s those outward focused activities that many times can lead to a breakthrough with a patient, be it emotional or physical. And, there is no understating the importance of that in modern medicine. I have been a personal witness to this in my own health struggles as well as my mother’s.

“Doctors need to defend these values based on altruism in the face of impersonal changes such as the worshiping of the electronic record,” states Dr. Samuels.

When it’s time to step away for the day, Dr. Samuels enjoys the simpler things in life. “I play the piano, read mainly non-fiction, running and spending time with my wonderful wife, Susan Pioli and our two Norfolk terriers, Ralphie and Sydney.”

Again, this isn’t surprising. It’s incredibly consistent with his professional life — serving others and working hard.

Oakstone is proud to call Dr. Samuels a Physician Partner. He serves as Course Director for the Comprehensive Review of Neurology and Neurology for Non-Neurologists, plus as a faculty speaker for our Comprehensive Review of Family Medicine. Whether you’re a patient, a colleague, or business associate Dr. Samuels is someone you want on your team.

 

About Dr. Martin A. Samuels:

Samuels is the founding chair of the Department of Neurology at the Brigham and Women’s Hospital, a position in which he served for 30 years until his transition to a senior neurologist position in 2017. He is one of the co-founders and a member in the interdisciplinary Program in Interdisciplinary Neuroscience at the Brigham and Women’s Hospital. He holds the Miriam Sydney Joseph Distinguished Chair of Neurology at Harvard Medical School, a chair that he named after his parents, the late Miriam Joseph and Sydney Samuels. Over the course of his career he has been honored with virtually every teaching and clinical award by numerous medical schools, national societies and his own Harvard Medical School. He is board certified in both Internal Medicine and Neurology, is a Master of the American College of Physicians, Fellow of the American Academy of Neurology, The American Neurological Association and the Royal College of Physicians, London. He has discussed a record thirteen Cabot Cases, clinical pathological conferences, published in the New England Journal of Medicine, and has been elected a convocation speaker a record three times at the Harvard Medical School. He created the Manual of Neurologic Therapeutics and has created the field of neurological medicine in the interface between internal medicine and neurology.  

VIDEO: Understanding the Effects of Vaping--E-cigarette/Vaping Associated Lung Injury

Lung injury associated with vaping began to appear in the summer of 2019 and has caused deaths in at least 21 states.

EVALI (Ecigarette/Vaping Associated Lung Injury) patients often appear with systemic symptoms, which present as an atypical pneumonia.

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Watch and learn as Dr. Caroline Chiles walks you through an EVALI patient’s medical timeline.

This presenatation is part of the National Diagnostic Imaging Symposium™. World Class CME's National Diagnostic Imaging Symposium™ is a comprehensive program featuring 115 presentations across 10 subspecialties, including Abdominal, Chest, Cardiovascular, Emergency, Genitourinary, Neurology, Musculoskeletal and Nuclear Medicine.

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Keys to Being a Successful Hospitalist and Understanding Hospital Length of Stay

*Editor's Note: This article was written before the COVID-19 pandemic. The views expressed here are not reflective of those atypical hospital scenarios. 

What hot topics and best practices in hospital medicine can you expect to hear more about in 2020 and beyond? We asked two experts for their take. Benjamin Frizner, MD, MBA, is Medical Director at BridgePoint Hospital in Washington, DC. David Fromberg, MD, is a hospitalist and family physician based in Marquette, MI.

Q.  An often-discussed topic in hospital medicine is length of stay. How is this being addressed where you practice?

A.  Dr. Fromberg: This is a metric that you see next to your name during hospitalist staff meetings. The length of stay for a patient involves so many different variables, most of which you do not have control over, including how social workers deal with placement, how consultants take part in patient care, taking over patient care from another provider, and pre-existing conditions. It is unfair to simply look at a number without considering these other factors.

Q.  How do you see the length of stay issue playing out over the next five to 10 years?

A.  Dr. Fromberg: Hopefully these metrics will be more reasonably calculated, as EMR systems are improved. This way, variables that are not under our control are factored in when calculating the result.

Q.  Can you address value-based care, care coordination, and other efforts being implemented to improve outcomes?

A.  Dr. Fromberg: My hospital is currently working to improve congestive heart failure readmissions. We have a committee made up of hospitalist team members, nursing staff, social work team members, and representatives from surrounding skilled nursing facilities. We are currently dealing with adherence to low-sodium diets. We can recommend them, but patients do not always follow them, so we are addressing this potential barrier. Staff weigh patients daily and reach out to intervene when certain measurement alerts are triggered. Weekend coverage is important for a program like this to be successful.

Q.  What are the keys for hospitalists to practice successfully in this environment?

A.  Dr. Fromberg: Be sure to keep up on the latest in treatment trends, have open lines of communication with team members to coordinate care, and easily view and track your own readmission data. Additionally:

      • make sure that documentation such as discharge summaries are completed on the same day of discharge,

      • check and recheck that patients have their medications, and

      • have an action plan in place for when discharged patients start to head on a downward path toward being readmitted.

It is also important that patients provide their preferred pharmacy information. Better still, see that patients have the bedside medication delivery program in place prior to discharge. Finally, ask patients and family members to verbalize their understanding of an agreed upon action plan.

A.  Dr. Frizner: Tracking 30-day readmission rates is controversial. Research suggests that physicians may delay sending patients back to the ED until they are out of the 30-day window. Also, hospitals are admitting patients under observation status instead of as inpatients and then expediting discharge so the patient does not fall into the 30-day readmission bucket.

 

Explore Hospital Medicine CME
Achieving Work-Life Balance and Recognizing Physician Burnout

Google “physician burnout” and you’ll find a plethora of articles, most of which acknowledge that more clinicians are suffering from burnout than ever. If that’s the case, can physicians ever really achieve a work-life balance?

The answer is yes — in a way. It’s possible for physicians to achieve a level of integration of their work and personal lives. “You can have satisfaction in terms of both your work and personal life,” says Diane Shannon, MD, MPH, ACC, a coach and consultant at Shannon Healthcare Communications, Brookline, MA. She is also the co-author of Preventing Physician Burnout: Curing the Chaos and Returning Joy to the Practice of Medicine. “But having everything in balance, all the time, and being able to do everything, I don’t think so.”  

“Burnout was occurring long before [the advent of] electronic medical records,” notes Prentiss Taylor, MD, FACP, Vice President of Medical Affairs at Doctor On Demand in Chicago and Chief Medical Editor at Oakstone. “[EMRs] exacerbated it, but burnout is something physicians have struggled with for decades. Early in my career I experienced burnout before I knew what to call it. But I changed my lifestyle, as well as the type of work I was doing to deal with it.”

What Is Burnout?

Before you can prevent it, you must know what burnout is. Experts break it down into three components:

  1. Emotional exhaustion – It’s more than just feeling that you need a vacation. It’s more of a sense that you just can’t go on any more.
  2. Depersonalization – This entails detaching from the emotional aspects of work.
  3. Inefficacy – This is a low sense of personal accomplishment in one’s work.

“I think about burnout in terms of three levels,” says Dr. Shannon. “There are individual factors, which are the personal stressors the physician brings with him or her to work every day, such as going through a divorce, caring for an elderly parent, and [living with] an untreated mental health issue or substance abuse. Then there are workplace factors, such as workload, the efficiency of the practice environment, and the amount of team support. Finally, there are external factors, such as changing patient demographics and the shifting regulatory landscape related to reimbursement, quality measures, and other domains.”

In speaking with many physicians over the past five years, Dr. Shannon has found that when asked what causes them the most stress, the number one response is EMRs and other items related to documentation, such as prior authorization.

Dr. Taylor says he knows very few physicians in traditional medical settings who can take a lunch break without various pressures. “They feel they need to use that time to catch up on messages, EMR tasks, etc., and that’s how they try to ‘efficiently’ manage their time so they can get out of the clinic or office at a reasonable time,” he explains. “Otherwise, that stuff tends to pile up throughout the workday and then you have all these unanswered calls and messages, and these things take time to handle.”

He adds: “That is one reason some physicians are attracted to telemedicine: thoughtful telemedicine group practices give them much more control over their daily schedule.”


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How is Artificial Intelligence Impacting Radiology?

What hot topics and clinical trends in radiology can you expect to hear more about in 2020 and beyond? We asked two experts for their take. David Naeger, MD, is Director of Radiology at Denver Health and Professor and Vice Chair of Radiology at University of Colorado School of Medicine. Elissa Price, MD, is Associate Professor of Clinical Radiology and Director of Clinical Operations in Breast Imaging for UCSF Department of Radiology and Biomedical Imaging.

Q. The most discussed topic in radiology these days seems to be artificial intelligence (AI). Do you see this much in your practice?

A. Dr. Naeger: I do not personally see much of this in daily practice, and I don’t think there are many widespread applications. Some sites across the country are demonstrating various AI products, but it is mostly in the experimental stage.

The big question is how to apply algorithms to modern medicine. For example, what is the work flow? The AI algorithm must be checked, so it becomes a question of efficiency. Also, “mostly correct” does not work well in medicine. When people or algorithms are incorrect, there needs to be accountability, and this has not been worked out for AI.

Dr. Price: In a very basic form, AI has existed in mammography for a long time. Specifically, computer-aided detection. Many practices use CAD as part of their standard workflow. Aside from that, although AI is a topic for frequent discussion in the breast imaging world, it is not having an impact on most clinical practices. There is a lot of research evaluating the use of AI to improve mammographic performance metrics. Results have been mixed.

Q. Where do you think AI in radiology will be in 5 to 10 years?

A.  Dr. Naeger: I think the accuracy of AI in targeted uses will improve dramatically. Some of the workflow and accountability issues will be resolved. Still, it will be expensive and a work in progress.

Dr. Price: There will be some form of AI in clinical practice, though I only see its realistic application in screening mammography. If a computer system could safely help us find more breast cancer, I am in favor of it.

Q.  Do you think breast imagers should be worried that AI may someday replace them?

A.  Dr. Price: I have no concerns whatsoever about that. So much of what we do involves patient communication and interaction. The diagnostic work up is an iterative process of problem solving and getting clinical context from the patient. No AI program can do all that.

Q.  Dr. Naeger, what about AI in thoracic imaging?

A.  Dr. Naeger: AI will likely help in screening chest radiographs for specific findings, as well as with pulmonary nodules on a chest CT. I think of radiographs the same way I do about EKGs, where a computer does a preliminary read of an EKG, which is then checked by a human. This could speed up preliminary interpretation and improve final accuracy.

For chest CTs, finding, measuring, and comparing nodules is tedious and won’t require a human once computers are good enough. The results will always need to be checked, however. I also can imagine the day when AI will help assess patterns of interstitial lung disease.

 

Explore Radiology CME