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My Kind of Medicine: Real Lives of Practicing Internists: Vineet Arora, MD, FACP

Vineet Arora, MD, FACP

Dr. Arora and her husband, David Meltzer, MD, PhD, at the underground “basilica cistern” in Istanbul in September.

Vineet Arora spent the better part of her 32nd birthday sitting on an uncomfortable wooden bench surrounded mostly by strangers. She was nervous and her stomach was growling, as she had arrived at 9 a.m. without having eaten breakfast, and had been there for five hours since. Finally, it was her turn. She stood up and introduced herself to the U.S. House of Representatives Health Subcommittee of the Energy and Commerce Committee and urged them to consider legislation that would halt Medicare payment cuts. She spoke of her love for internal medicine and how much it meant to her to have ongoing relationships with her patients. “It was a big moment,” she remembers. “I was there to represent the voice of the future—of so many young people who don’t have a voice. It was an honor.” Her boyfriend at the time, unable to attend because of a work obligation, had been intermittingly leaving a meeting to watch her on CSPAN. After she finished her testimony, he sent her an e-mail. “He said that I looked really hungry!” she recalls with laughter.

The Advisor
In 1996, physicians Robert Wachter and Lee Goldman published an article in the New England Journal of Medicine about the emerging role of physicians practicing general medical care of hospitalized patients. A “hospitalist” they called it—a foreign term for a brand new concept in U.S. health care. As she read the article from her apartment in St. Louis, where she was in her third year of medical school at Washington University, Vineet Arora was intrigued. Today, the energetic 34-year-old is a practicing hospitalist at the University of Chicago. She is also a researcher, an Assistant Dean of Curricular Innovation and an Associate Program Director of the Internal Medicine Residency Program at University of Chicago’s Pritzker School of Medicine. It is an expansive, diverse and busy career that fits the lively, quick, and energetic Dr. Arora like a glove. Her training as an internist in many ways served as a catalyst for all of it.

Dr. Arora values each role for different reasons and says they complement each other. For example, while working her rounds as a hospitalist, she can see first-hand how a program is or is not working, or pick up on things that would interest her as a researcher, such as “transitions in care”—the transferring of patient care from one shift to the next—that she has recently begun to pursue. “What I like about research is thinking about a problem and coming up with a systematic way to deal with it,” she says. “So my clinical work helps me to define problems and develop programs to address them. In her role of Assistant Dean and Associate Program Director, she thrives from her work with students. “As a career advisor, I get to know students really well in the role,” she says, “and everyone is so different. The most important thing I need to teach them is to look past the immediate and to see the long run. I have to make sure they are really passionate about what they’re doing.”

It is in this role in particular that Dr. Arora seems to shine brightest. In a video on doctorschannel.com, she is all at once informative, authoritative, accessible, and likable as she rattles off tips for applying for residency. She gives off a positive energy and a youthful air, and when she talks about mentoring it is obvious that she takes it to a higher level, beyond the few token “words of advice.” She draws upon her own experience when appropriate to do so, for example, encouraging residents to pursue public policy, as she did herself at the Harris School at the University of Chicago. “In residency, the goal is to become the best doctor you can be,” she says, “but people have other interests, too. I try to keep a resident’s spirit alive. If someone has an interest in something like that, I try to cultivate it and make it grow.”

Would she recommend hospital medicine for a career? “My job is to advise medical students on their career choice, and while I think hospital medicine is a great career, I have to add that it is important to know who you are,” she says. “People also go through a lot of personal changes and you have to take that into consideration. It can be intense at times, which is why I advise on a case-by-case basis.”

Bread and Butter

Dr. Arora’s experience with her own mentors helped shape her decisions to pursue both internal medicine and hospital medicine. “It was from a mentor who was an endocrinologist that I first learned about internal medicine,” she says. “She was my clinical skills preceptor and I remember she would review our videos and give us feedback on them. Looking back on it I think how bad we must have been! But she was very patient with us.” Dr. Arora says what set her apart was her willingness and enthusiasm to share with the students. She cites a patient case in which the patient had been suffering from an enlarged thyroid, caused as they eventually learned, by a viral infection—a fairly uncommon occurrence for the presenting symptoms. “It’s one of those things you read about,” she explains. “And I thought it was great that she took the time to explain that to us. It’s nice when someone goes out of their way to teach you.”

From another mentor, she learned about hospital medicine. “The hospitalist who I spent my rounds with was very solid in evidence-based, bread-and-butter topics, and I learned a lot from him. There was one time in particular I remember when he really taught us something interesting. We had several patients come in with a high fever, and since many of them were diabetic and elderly, we began treating them with broad spectrum antibiotics. Well, this hospitalist suggested doing an influenza nasal swab and they came back positive. Three or four cases of flu were discovered on the ward. It was a great moment of ‘Wow, you can really make a contribution by making the right diagnosis.’”

During residency, Dr. Arora was named chief resident which she considered an honor. Later, instead of subspecializing, she chose to pursue the systems and public policy training that she had developed an interest in while in college at Johns Hopkins in Baltimore, Maryland. She says knowing how to get the right training in public policy and combining it with research can be confusing. “During college I took health administration courses but at no point did I think that I should dive into another degree. I didn’t know how to integrate it into my career. I think there’s some confusion about this path…one thing students and residents should keep in mind is that getting additional training is important.”

A recent example of how she combines her public policy training with research work is a study she recently published with colleagues in the September 10 issue of the Journal of the American Medical Association on the effect of reduced shift lengths for first-year medical residents. The study concluded that cutting shift lengths is not effective in reducing fatigue-related errors by first-year medical residents if the workload is not reduced as well, but instead packed into fewer hours. “While people have been focusing a lot on the number of hours and resident fatigue, it’s also important to focus on workload and on handoff errors and communication around shift change,” Dr. Arora said in an interview on the study. She explains how the study is a good example of policy-relevant research. “One policy can lead to multiple projects,” she says, “with all of the policies being released on a regular basis, there are boundless opportunities.”

Far Sighted

Dr. Arora’s personal experience has taught her important lessons. “One of the most difficult things as a researcher has been getting rejected from grants or publications,” she explains. “Rejection is a major part of life as a researcher, so early rejections, while tough, are an important part of growing and moving forward in your career. If you don’t have the experience of failure, you can never really enjoy success.”

She recalls being told this while listening to the introductory remarks of a senior investigator at a grant competition. “He talked to us about the grant application process and said that it was how you handle rejection that ultimately defines your ability to succeed in your long term career,” she says. About a week afterwards, the investigator called Dr. Arora and informed her that she would not be receiving the grant she had recently applied for, but that he hoped she would remember his words from the week before. When he called, Dr. Arora happened to be with one of her research fellows. When she hung up the phone and told her research fellow that she had not gotten the grant, they were dumbfounded by her response. “She said that if it had happened to her she would have been in tears,” remembers Dr. Arora. “And I just repeated what he had told me.” Later, when the same fellow was both awarded with her first big grant and rejected for another within a week, Dr. Arora says she was impressed by how well she had taken this advice to heart. “She was excited about her success but also took her failure really well and learned from it. It was rewarding for me to observe that.” Dr. Arora’s work with people from high school all the way up to co-faculty has made it a learning process on both ends, as she explains. “One of my most rewarding career experiences has been training and mentoring others in research,” she says. “I may teach others but I also learn how to be a better mentor and how to help people succeed to their fullest. I’d say it is definitely the best part of my job.”

In her down time, Dr. Arora likes to travel with her husband of two years, David, who is also a researcher and a health economist. They traveled to Turkey in September. “We try to take one big trip a year—it’s our getaway time,” she says. They met at work and were colleagues for about a year and half before they started dating. “We don’t have an interesting story!” she insists, but later adds that her most favorite quality of her husband’s is that he knows how to have a good time. She says he’s “really smart” but qualifies that while everyone sees this side of him, as his wife, she appreciates other things. “He makes me laugh!” she says. For Dr. Arora’s hectic life laughter must be the perfect remedy, just as it was three years ago on that fateful birthday. Sometimes the best stories are the simplest ones.

Check out previous articles as physicians share what motivated them to become physicians as well as why they chose their particular type of practice.

Back to October 2008 Issue of IMpact

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