Geeta Singhal
1. The division of pediatric hospital medicine at your institution formed out of the pediatric emergency medicine division. What did you learn from working in the ER that helped you in your career as a hospitalist?
Wow! Where to start? In retrospect, it was an invaluable beginning. PHM has experienced a lot of the growth that PEM has in the past. We have learned from PEM about board certification, fellowships and shift work. A lot of what we did when PHM became its own section at Texas Children's Hospital was based on the PEM section administrative make up. As a hospitalist, I learned about patient flow and the care of acutely ill children. I think that we are following in their footsteps, both clinically and academically, and there is a lot to learn from PEM. It is also important that we continue our close collaboration to continue to enhance patient care: from discussions about what patients need to be admitted and what patients can go home to interventions that can start in the ER to reduce length of stay, and continued work together on quality and research projects.
2. One of your passions is faculty development and you are currently the former director of the office of faculty development at Baylor College of Medicine. What are some steps that newer and evolving hospitalist programs can take to promote and improve faculty development at their own institutions?
I see pediatric hospitalists as key educators for medical students and residents. We remain general enough that we can teach, in one day, from renal to neuro to endocrine, without blinking an eye. We have a great opportunity to teach communication with patients and their families, patient flow, care coordination and so many other things that go into being a doctor that cannot be taught in the textbooks. For those reasons, I think that hospitalists should learn about the science of teaching as we are often called to teach, and it is often an integral part of our day. The teaching can bring us joy as we are impacting the next generation of physicians. Suggested steps are to start small. See what your division needs. Call upon experienced teachers to come talk about how to teach on rounds, how to give a great talk, and the perennial favorite, how to give feedback! Read about educational innovations, whether in Pediatrics, Hospital Pediatrics, the Journal of Graduate Medical Education, Medical Teacher and countless others. You may have access to faculty development programs where you work so you can check that out. We now have the award-winning APEX PHM faculty development program, run by educational leaders in our field that I highly recommend. There is also the Academic Pediatric Association Educational Scholars Program where you will gain lifelong skills in educational scholarship. Both of these national programs offer opportunities for networking and collaboration.
3. You are known for being very calm with families and have even co-authored a MedEdPortal publication entitled, “Challenging Situations in Family Centered Rounds: Making the Best out of Worst Case Scenarios.” What advice do you have for improving bedside manner and alleviating tension with difficult families or in tough situations?
I try to think how I would feel is this is my child. This gentle reminder to myself before talking with the family allows me to have a mindset of compassion and remain composed. I also remind myself that when a family is angry, they really aren't angry with you. They are angry with the white coat and what we represent. Sometimes, to a family, I represent the ER, the system, the hospital, or the consultant. I also remind myself that often underlying the anger is fear. The parents are so frightened, exhausted, and overwhelmed. I am actually amazed that we don't have more angry and frustrated families. For me as a parent, there is nothing more precious to me than my children. However much I value making contributions as a hospitalist, nothing is more important than my children. So, to have an upset family about their child, I can see and understand that. When working with families, besides my self-pep talk, I also purposely modulate the tone of my voice to a calm and somewhat lower tone. I also sit down when speaking with the family and listen much more than I speak. For some parents, depending upon the circumstances, I may give the caregiver a hug or simply just offer something for them to eat and drink. You would be amazed to see a mom just get tears in her eyes when her child's doctor brings the mom a sandwich and a soda: so quick for me to do and so helpful in building rapport and trust.
4. During a panel for pediatric hospitalists, you were asked to describe our role and you stated that “we…provide the majority the inpatient teaching to medical learners in many academic centers.” What adaptations have you made for millennial learners and what are your favorite teaching pearls for efficient teaching during rounds?
Short and sweet! First, I try really hard to empower the senior resident and fellow to teach. I ask a lot of critical thinking questions and preface my questions with, "there is no right or wrong answer. I just want to hear what you are thinking." I also ask questions such as, "tell us one thing you have learned today that will inform your care of future children." The learners seem to really like that question and appreciate that I want to hear what they have learned instead of me being the "sage on the sage." I also will throw out random sample board and shelf questions that always seem to get the learners' attention. Also, remember that we are role models and we are, whether with realization or not, teaching all the time through our actions. I now think about how I speak with the nurse, answer the 30th admission call from the ER, handle interruptions during rounds etc. The learners are watching and picking up our habits and approaches, both good and bad.
5. The Atlantic magazine recently interviewed you for an article entitled, “Rooting Out Diagnostic Error In Health Care.” In the article, you talk about how important the family’s input is to you in avoiding diagnostic error and how their acceptance of a diagnosis is validating. Can you explain what you meant by this?
Sure. When I have a hospitalized patient with diagnostic uncertainty, I am looking to the families' reaction to see if they agree with me. Sometimes, again depending upon the situation, the caregiver will look relieved and in agreement, puzzled, or downright confused. Sometimes the caregiver will tell me, 'that makes sense to me about my child," or sometimes they’ll say, “I am not a doctor, but this doesn't make sense to me." These are powerful cues that we can use to see if we are on the right track or not. Basically, I try my best to partner with the family in making the diagnosis. In full disclosure, I make diagnostic errors and I study diagnostic errors.
6. Jack Percelay often ends his list-serve commentary with the phrase “that’s just my 2 pennies.” what are your two cents? (Feel free to write about something that hasn't been mentioned here)
My 2 cents? That we are so lucky to be part of this ever growing, changing, and innovative field. I finished my residency when there was no such concept as a pediatric hospitalist. Now I attended the national PHM meeting in Nashville with 1200 people like me. How fun and exciting!
Wow! Where to start? In retrospect, it was an invaluable beginning. PHM has experienced a lot of the growth that PEM has in the past. We have learned from PEM about board certification, fellowships and shift work. A lot of what we did when PHM became its own section at Texas Children's Hospital was based on the PEM section administrative make up. As a hospitalist, I learned about patient flow and the care of acutely ill children. I think that we are following in their footsteps, both clinically and academically, and there is a lot to learn from PEM. It is also important that we continue our close collaboration to continue to enhance patient care: from discussions about what patients need to be admitted and what patients can go home to interventions that can start in the ER to reduce length of stay, and continued work together on quality and research projects.
2. One of your passions is faculty development and you are currently the former director of the office of faculty development at Baylor College of Medicine. What are some steps that newer and evolving hospitalist programs can take to promote and improve faculty development at their own institutions?
I see pediatric hospitalists as key educators for medical students and residents. We remain general enough that we can teach, in one day, from renal to neuro to endocrine, without blinking an eye. We have a great opportunity to teach communication with patients and their families, patient flow, care coordination and so many other things that go into being a doctor that cannot be taught in the textbooks. For those reasons, I think that hospitalists should learn about the science of teaching as we are often called to teach, and it is often an integral part of our day. The teaching can bring us joy as we are impacting the next generation of physicians. Suggested steps are to start small. See what your division needs. Call upon experienced teachers to come talk about how to teach on rounds, how to give a great talk, and the perennial favorite, how to give feedback! Read about educational innovations, whether in Pediatrics, Hospital Pediatrics, the Journal of Graduate Medical Education, Medical Teacher and countless others. You may have access to faculty development programs where you work so you can check that out. We now have the award-winning APEX PHM faculty development program, run by educational leaders in our field that I highly recommend. There is also the Academic Pediatric Association Educational Scholars Program where you will gain lifelong skills in educational scholarship. Both of these national programs offer opportunities for networking and collaboration.
3. You are known for being very calm with families and have even co-authored a MedEdPortal publication entitled, “Challenging Situations in Family Centered Rounds: Making the Best out of Worst Case Scenarios.” What advice do you have for improving bedside manner and alleviating tension with difficult families or in tough situations?
I try to think how I would feel is this is my child. This gentle reminder to myself before talking with the family allows me to have a mindset of compassion and remain composed. I also remind myself that when a family is angry, they really aren't angry with you. They are angry with the white coat and what we represent. Sometimes, to a family, I represent the ER, the system, the hospital, or the consultant. I also remind myself that often underlying the anger is fear. The parents are so frightened, exhausted, and overwhelmed. I am actually amazed that we don't have more angry and frustrated families. For me as a parent, there is nothing more precious to me than my children. However much I value making contributions as a hospitalist, nothing is more important than my children. So, to have an upset family about their child, I can see and understand that. When working with families, besides my self-pep talk, I also purposely modulate the tone of my voice to a calm and somewhat lower tone. I also sit down when speaking with the family and listen much more than I speak. For some parents, depending upon the circumstances, I may give the caregiver a hug or simply just offer something for them to eat and drink. You would be amazed to see a mom just get tears in her eyes when her child's doctor brings the mom a sandwich and a soda: so quick for me to do and so helpful in building rapport and trust.
4. During a panel for pediatric hospitalists, you were asked to describe our role and you stated that “we…provide the majority the inpatient teaching to medical learners in many academic centers.” What adaptations have you made for millennial learners and what are your favorite teaching pearls for efficient teaching during rounds?
Short and sweet! First, I try really hard to empower the senior resident and fellow to teach. I ask a lot of critical thinking questions and preface my questions with, "there is no right or wrong answer. I just want to hear what you are thinking." I also ask questions such as, "tell us one thing you have learned today that will inform your care of future children." The learners seem to really like that question and appreciate that I want to hear what they have learned instead of me being the "sage on the sage." I also will throw out random sample board and shelf questions that always seem to get the learners' attention. Also, remember that we are role models and we are, whether with realization or not, teaching all the time through our actions. I now think about how I speak with the nurse, answer the 30th admission call from the ER, handle interruptions during rounds etc. The learners are watching and picking up our habits and approaches, both good and bad.
5. The Atlantic magazine recently interviewed you for an article entitled, “Rooting Out Diagnostic Error In Health Care.” In the article, you talk about how important the family’s input is to you in avoiding diagnostic error and how their acceptance of a diagnosis is validating. Can you explain what you meant by this?
Sure. When I have a hospitalized patient with diagnostic uncertainty, I am looking to the families' reaction to see if they agree with me. Sometimes, again depending upon the situation, the caregiver will look relieved and in agreement, puzzled, or downright confused. Sometimes the caregiver will tell me, 'that makes sense to me about my child," or sometimes they’ll say, “I am not a doctor, but this doesn't make sense to me." These are powerful cues that we can use to see if we are on the right track or not. Basically, I try my best to partner with the family in making the diagnosis. In full disclosure, I make diagnostic errors and I study diagnostic errors.
6. Jack Percelay often ends his list-serve commentary with the phrase “that’s just my 2 pennies.” what are your two cents? (Feel free to write about something that hasn't been mentioned here)
My 2 cents? That we are so lucky to be part of this ever growing, changing, and innovative field. I finished my residency when there was no such concept as a pediatric hospitalist. Now I attended the national PHM meeting in Nashville with 1200 people like me. How fun and exciting!