Why I Continue to See Patients
Editor’s Note: The passage below was excerpted from Dr. Raymond’s monthly Letter from the President to MCW faculty, staff and students, disseminated on September 3, 2021.
On September 2, I completed my annual summer clinical service at the Zablocki VA Medical Center in Milwaukee – and I would like to share why I look forward to this meaningful opportunity each August.
My love of the challenges and privileges of the patient-physician relationship were formed during my medical education at The Ohio State University and training at Duke University; throughout my internal medicine internship and residency, chief medical residency and nephrology fellowship, I learned of the awesome power of the science and the humanity of medicine. As I assumed increasing research and administrative duties throughout my career, I strove to maintain a robust array of clinical duties to bring meaning to my nonclinical duties.
As a nephrologist, I care for men and women with hypertension, diabetes and other causes of renal failure. For seven years early in my career, I was chief of an exceptionally busy renal section at the Durham Veterans Administration Medical Center. As a faculty member, I also was responsible for 100 renal transplant patients and 150 home dialysis patients. Those experiences honed my skills as a physician and forged a lifelong commitment to veterans and patients with renal diseases.
For several weeks each summer at the Zablocki VA, I see patients with chronic renal failure, provide consultations, care for patients in the dialysis unit and tend to acutely ill kidney patients in the ICU and emergency department. I cherish the opportunity to care for patients, especially veterans. As importantly, continuing to see patients shows our stakeholders at MCW that I am a faculty member as well as an administrator – and that I am making a sincere effort to remain in touch with critical front-line issues that impact our clinical enterprise.
For the past two years, treating patients at the VA during the COVID-19 pandemic has enhanced my commitment to speak clearly and candidly about what we can do to combat this deadly disease. We all have had to learn how to deliver the best patient care possible in new ways. As a nephrologist, the physical examination to evaluate the state of a patient’s hydration is essential to making sound decisions for critically ill patients.
Because one of the interventions that many hospitals have undertaken during the pandemic is to minimize the number of providers who actually can go into a patient’s room, I have had to change my practice and learn to rely on the physical examination and the judgment of others – such as ICU doctors, hospitalists and bedside nurses – for clues about what to recommend for fluid resuscitation, diuresis and renal replacement therapy. This new reality has given me a profound appreciation for the skills and judgment of other team members and has helped to bring the nephrology consultants closer to our ICU colleagues.
I also love talking to patients and their families – although wearing a mask, gowning up and practicing social distancing places barriers between the patient and the provider, and this has posed a personal challenge for me because of the way I like to practice medicine. However, even though I have been a physician for almost 40 years, in medicine one constantly has to learn, adapt and reinvent the way that we care for patients. The lesson for all of us in academic medicine is that we need to continue to adapt to different ways to educate, conduct research, treat patients and support the health of our communities.