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GUEST POST: New beginnings and innovative ways to serve, to share, and to solve

Thursday, June 6, 2013

"But I know one thing:  the only ones among you who will be really happy are those who have sought and found how to serve." ~ Albert Schweitzer Dec 3, 1935

Dr Joel Topf (pictured here) writes: July first is approaching and with it, the anxiety of freshly minted doctors. However take heart, green doctors, you are not alone, current interns about to lose the senior resident security blanket, soon to be fellows, nurses, program directors and clued in patients all share your night terrors from the most feared date in academic medicine, July first.

July first also signifies a new beginning. This may be the most important beginning of your entire life and beginnings are opportunities to reform and reorient yourself. Take this moment to decide and mold yourself into the doctor you want to become. At the outset of my residency, my concern was entirely on becoming a competent physician. With hindsight, I believe that to be a misguided concern. Residency works. Residency will turn you into a capable clinician. Competence will be pounded into you and you will be a confident physician upon graduation. The question you should be asking, is what type of physician will you become, and here there are some real choices.

If I was a program director I would make Ora Pescovitz’s brilliant essay Swimming in the Sea of Galilee required reading for every incoming intern. Dr. Pescovitz, a pediatric endocrinologist of note, expresses better than I ever could, the value of giving back to the profession that will give you so much. Think about this as you develop as a doctor and take steps to give to the field rather than just receive.

Obvious ways to give back are research and teaching. These are activities that are prominently modeled in front of you. I’d like to share a less obvious way of giving back. When I was a Med-Peds resident at Riley Children’s Hospital in Indianapolis I remember dog-earing a dozen pages in my Harriet Lane Handbook. These pages contained the age-based normals for kids; one page with growth tables, another with PFT normals, another with blood pressure targets.*  These pages were well worn as I flipped through them on every admission. The variety and specificity of the data was astounding, beyond vitals, there were growth rates, EKG findings, lab results, behavioral milestones, dietary serving sizes and nutrition recommendations. I began to redefine growth as a constantly changing definition of normal.

I quickly frustrated with the incessant flipping from page to page of my Harriet Lane and photocopied the relevant pages into a booklet.  This was an improvement, but it still did not provide the solution I was looking for. Instead of looking up my patient's age and gender on each chart I wanted to match age and gender once and have all the various age-based data displayed in front of me. I wanted a computer program of age-based normals and I teamed up with a fellow resident, Burke Mamlin, to build the dream. He was the code jockey and I was the editor. Together, working nights and weekends for about a year, we put together Kidometer, a comprehensive, interactive, database of age-based normals.

They say that necessity is the mother of invention; well if that’s the case, residency is the mother of necessity. As a resident the work will sometimes seem overwhelming and you will develop dozens of hacks to improve your efficiency. Don’t keep these tricks to yourself. Constantly look to your frustrations, your pain points. Those are areas ripe for contributions.  Find your solutions. Do it for fame, do it for money, do it for personal satisfaction. It doesn’t matter. What matters is sharing. Don’t complain in private, innovate in public.

*Funny story: in the 1980’s the first pediatric blood pressure targets defining hypertension were published. Like all other pediatric normals, they were normed to age. Endocrinology and Cardiology specialists offices were soon crowded with newly diagnosed hypertensive kids and nearly every one of them were tall, often, exceptionally tall. Pediatricians quickly realized that blood pressure needed to be normalized to the age and height of kids. While people laughed at the overdiagnosis of hypertension in the tall, the under-diagnosis of clinically significant hypertension in the short was not as funny.  Since those first tables, all blood pressures have been normed to height and age.

ABOUT OUR GUEST POST CONTRIBUTORJoel Topf, MD, is a Detroit native. Following undergrad at the University of Michigan he went to Wayne State University School of Medicine. During medical school he wrote a Microbiology Study guide which sparked his interest in education and information design. During a Med-Peds residency at Indiana University he co-authored a fluid and electrolyte text book which led to a nephrology fellowship at the University of Chicago. He currently is an Assistant Clinical Professor of Medicine at Oakland University William Beaumont School of Medicine, and teaches residents and fellows at St. John Hospital and Medical Center back in Detroit. Since 2008 he has written a nephrology blog focused on teaching clinical nephrology at


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