Associate Professor in Medicine-Nephrology
MD: Albert Einstein College
Residency: Bronx Municipal Hospital Center
Fellowship: Hospital of the University of Pennsylvania
How has caring for a nephrology patient changed during your career?
The actual care of the patient—that is, the interaction of the patient and the longevity of the relationship--hasn’t changed. We take care of patients for a long time: first, they have chronic kidney disease, then they’re on dialysis and finally they get a transplant. That’s the part that I enjoy the most. There have definitely been medical breakthroughs, but the crux of it--the patient/physician relationship--hasn’t changed.
Did you consider an administrative role during your medical education?
No, I decided I was going to be a clinician. Once I was in the clinic, I found there were several opportunities to help establish programs within nephrology and to help coordinate the clinic; I realized that I could impact the way that patient care was delivered on a larger level, and so agreed to help. I now coordinate medical specialties (Allergy, Rheumatology, Nephrology, Pulmonary and Endocrinology) and medical surgical subspecialties. Working with surgery has definitely been a process-- learning about how surgeons see and manage patients. It’s very different from medicine.
What projects are you working on now?
About a year ago, Craig Langman and I started a chronic kidney disease transition program at Lurie Children’s Hospital. We run a monthly clinic for patients that are transitioning from Children’s to NM. Patients are anywhere from 18-21 years old, which is a really vulnerable age. Before this program was developed, I would see these patients on the adult side. They were shell-shocked, and they would often slip through the cracks. They would have to make appointments on their own and often would no-show or wouldn’t follow up. They are very medically complex patients, and were at high risk for complications. The pediatricians would discharge them from their practice once they were older, and they didn’t feel connected over here. Having seen the no-show rate, I reached out to pediatrics and asked if I could come over to Children’s and see the patient in that setting. They could then get to know me and become comfortable with me in that environment. Now they leave Children’s with an appointment in hand. The program’s been up and running for about a year and we’ve only had one person no-show.
At the opposite end of the spectrum, with the help of Kathy Neely, I found that we were seeing a lot of patients who we would automatically start on dialysis while they were dying. It was really hard to watch. A lot of that decision, we felt, was just sort of automatic. Kidneys fail as you die, and so we would be called in to start dialysis. I think that as nephrologists, we weren’t trained to bring up the option of palliative care. Now we’re teaching fellows how to have end of life conversations with families. The conversation is to talk about the action of not-starting dialysis, or starting it on a limited basis, for example, a week. We teach the fellows to think about palliative care as an option. We take them to Northwestern Simulation where faculty watch them have a conversation with a standardized patient actor, and then give them feedback. It has made the fellows more aware of thinking about the best options at the end of life. It’s important to stop and think and look at the whole picture.
Finally, I am also starting to work with members of the rheumatology division on studies related to renal involvement of lupus and scleroderma. With Rosalind Ramsey-Goldman and Christine Hsieh, we hope to start a lupus clinical group that would address all the needs of the lupus patient and hopefully collaborate on research studies on this population. In addition, we are working with John Varga and the scleroderma program to try to understand and to intervene on scleroderma renal crisis.
How did you balance having a family and having a demanding career?
It helped to have a supportive partner in Rod Passman. I didn’t want to miss out on my kids when they were young; I didn’t want to be one of those parents who didn’t make it to the play. I made it a priority to be there when they were little, and so didn’t miss any major events. The EHR changed my whole life. It was great when I figured out that I could do my notes from home: I could get home, be with the family, and once the kids went to bed, I would go back to my work. It offered me flexibility if I needed to leave to pick up your kids, and still get my work done. But you do what you need to do to make it happen. When the kids go to bed, you’re back on.