- Jen Fuchs
1. You have been the webmaster of the SOHM library website for several years. As it transitions to its new home on the AAP collaborate page, can you reflect on how the website has evolved? And what do you see in the future for the library?
Despite complete lack of IT training, I became involved in improving the SOHMlibrary site as part of a fellowship project. I suggested some content to Lindsay Chase, who was the webmaster at the time, and she assigned me the task of creating new content for the site. From there, my involvement grew and before I knew it, I was running the website. It is odd to be answering my own set of questions for the hospitalist corner as this page started as an excuse to get to ask questions of the great minds of PHM. The website started as a way to collect all of PHM’s amazing work and disseminate it. One of my favorite things about our subspecialty is how helpful and collaborative we are – both via the ListServ and the website. This was very apparent during the start of the pandemic, when Seattle and New York shared their experiences to help others and our med-peds colleagues stepped in and created crash courses for those of us seeing adults. The website will be transitioning over to the AAP site, which is very exciting because it means that we can focus on content and new ideas and leave the IT/tech stuff to the experts! In the future, I hope the website will become a “one-stop shop” for learners young and seasoned – a place for resources, interactive discussions, new studies and ideas, and sharing knowledge.
2. Part of your time is spent with the inpatient child abuse team at UNC. How did you get involved with this care? And getting a subpoena for a NAT case is always stressful—any advice you can offer?
I had a wonderful mentor in residency who taught me that no matter what specialty you go into, unfortunately, you have to think about child abuse on your differential. She was the head of our emergency room and ended up identifying a lot of cases just by looking for it and asking questions. I am by no means an expert, but the team at UNC is incredibly talented and needed some help so I started doing some time on that service. Statistics show that we don’t think about abuse enough - up to 1/3 of young children (<12 months) have a minor injury prior to a severe abuse diagnosis. The kids I see saw a medical provider who had the chance to help them prior to being hospitalized with severe injuries – that’s why I continue working on the team and educating our learners. The best advice I can offer for identifying abuse is just to do a very thorough exam (get the child naked), be inquisitive, and pause when things don’t make sense – just like re-working a differential diagnosis in hospital medicine. You would be amazed at how many times I identify a concern just by asking the parents a question or calling a PCP and chatting. This advice will also serve you well when testifying because your notes and the details that stick out will help you to remember.
3. As the recipient of the UT Southwestern Children’s Faculty Teaching Award in 2019, what is your teaching style?
This is so challenging to define. I think my teaching style is an amalgamation of all of the great mentors I’ve had over the years. I definitely lean into patient-centered care, high-value care, and evidence-based medicine. I would rather a learner think about the why behind what they are doing than to “get the answer right.” I also try to utilize all of our resources – if child life or nursing has a suggestion, take a minute to ask them to teach you or explain. The residents at UTSW taught me a lot about keeping the fun and humor in medicine, which makes us all more willing to learn! And lastly, I think helping out learners when it is busy or stressful (by discharging a family before rounds or writing that H&P yourself) allows them a chance to absorb the teaching better.
4. At PHM 21, you co-led a great talk on subcutaneous rehydration therapy. Can you tell us more about the patients that benefit from this treatment? And how do you explain it to patients and parents—are they usually receptive?
I wish we offered it to families more! UNC sees a very large number of complex patients, often resulting in difficulty obtaining IV access. Our emergency room started using SCRT years ago very effectively and we now use it about once a month, with hyaluronidase. It is ideal in patients where IV access is challenging and an ND tube is contraindicated. A perfect example is a complex patient with a dislodged GJ tube who just needs overnight hydration until radiology can replace the tube in the morning. We also use it as a bridge to IV therapy as our nurses feel that it often “plumps up” the child’s veins, making access easier. It is important to prep the parents so that they know what to expect – you should see some swelling, it may look pink (not red), and is less painful than an IV (I made sure to have SCRT myself so I could honestly share my experiences with families). Most parents aren’t as shocked by the idea as you might think.
5. You are the program director of the PHM fellowship at UNC Children’s Hospital. How do you ensure autonomy and mentorship during fellowship training?
Great question and a great challenge. It is important to understand that fellows are not glorified residents. They are essentially new attendings getting a crash course in PHM and finding their own clinical and teaching style. It is actually harder to provide valuable feedback and autonomy to a fellow than to lead a team yourself, but it is way more rewarding. We try to provide fellows with the tools necessary to create a strong mentorship relationship – by setting expectations and having them come to the mentor with as much effort as expected from the mentor. Another great tip is to ask the fellowship administrator what individual might be a good mentor for the fellow. This is how I found my fellowship mentor because our admin knew what sort of personality and style I needed in a mentor and could identify the perfect individual.
6. With Drs. Rubenstein and Chase, you wrote “Things we DON’T Do for No Reason” in Hospital Pediatrics. Can you tell us where you came up with the idea? You discussed three examples but said “[we] encourage this discussion to continue, at conferences, meetings and break rooms everywhere.” Will there be future lists (or any ideas you can share with us)?
I always enjoy working with these two! The idea came from us venting about how sometimes we in PHM focus so hard on safely doing less that we forget about opportunities where doing more has been shown to be better. Jared Rubenstein (a genius in his own right, check out his youtube: https://www.youtube.com/watch?v=BbNi_-wYXJE) came up with the term “safely doing better,” which I love. Reducing unnecessary care is absolutely important, and I would not dare to imply otherwise. Along with safely doing less, though, we need to start identifying where additional care IS necessary and where our practice is lagging behind or not aligned with best evidence. In addition to the three examples in the paper, we also came up with a list that included things like early discussion of goals of care, contraception counseling in hospitalized patients, and catch-up immunizations for hospitalized patients. If anyone has any other ideas, I would love to collaborate on another article.
7. Jack Percelay often ends his list-serve commentary with the phrase “that’s just my 2 pennies.” What are your two cents?
Cent #1 – Listen to your nurses and include them in care plans/decisions. This has saved me numerous times over my career and also taught me so much. When I think back over my career, I have had the pleasure of working with some of the most compassionate, amazing nurses who have solved my diagnostic dilemmas or created solutions to patient care issues while we changed a diaper together or helped a patient get up to the restroom. Nurses are the most valuable tool a pediatric hospitalist has! I think we really need to think, as a PHM collective, about the role we have in combating the nursing shortage and nursing burnout.
Cent #2 - Denzel Washington once said, “Show me a successful individual and I’ll show you someone who had real positive influences in his or her life.” I am the product of many amazing mentors who saw possibilities in me that I didn’t see in myself (including running this website!). To those individuals, I want to say ‘thank you,” I am eternally grateful. I can only hope to pass that along to others in the future. Never underestimate the power of a good mentor!
Despite complete lack of IT training, I became involved in improving the SOHMlibrary site as part of a fellowship project. I suggested some content to Lindsay Chase, who was the webmaster at the time, and she assigned me the task of creating new content for the site. From there, my involvement grew and before I knew it, I was running the website. It is odd to be answering my own set of questions for the hospitalist corner as this page started as an excuse to get to ask questions of the great minds of PHM. The website started as a way to collect all of PHM’s amazing work and disseminate it. One of my favorite things about our subspecialty is how helpful and collaborative we are – both via the ListServ and the website. This was very apparent during the start of the pandemic, when Seattle and New York shared their experiences to help others and our med-peds colleagues stepped in and created crash courses for those of us seeing adults. The website will be transitioning over to the AAP site, which is very exciting because it means that we can focus on content and new ideas and leave the IT/tech stuff to the experts! In the future, I hope the website will become a “one-stop shop” for learners young and seasoned – a place for resources, interactive discussions, new studies and ideas, and sharing knowledge.
2. Part of your time is spent with the inpatient child abuse team at UNC. How did you get involved with this care? And getting a subpoena for a NAT case is always stressful—any advice you can offer?
I had a wonderful mentor in residency who taught me that no matter what specialty you go into, unfortunately, you have to think about child abuse on your differential. She was the head of our emergency room and ended up identifying a lot of cases just by looking for it and asking questions. I am by no means an expert, but the team at UNC is incredibly talented and needed some help so I started doing some time on that service. Statistics show that we don’t think about abuse enough - up to 1/3 of young children (<12 months) have a minor injury prior to a severe abuse diagnosis. The kids I see saw a medical provider who had the chance to help them prior to being hospitalized with severe injuries – that’s why I continue working on the team and educating our learners. The best advice I can offer for identifying abuse is just to do a very thorough exam (get the child naked), be inquisitive, and pause when things don’t make sense – just like re-working a differential diagnosis in hospital medicine. You would be amazed at how many times I identify a concern just by asking the parents a question or calling a PCP and chatting. This advice will also serve you well when testifying because your notes and the details that stick out will help you to remember.
3. As the recipient of the UT Southwestern Children’s Faculty Teaching Award in 2019, what is your teaching style?
This is so challenging to define. I think my teaching style is an amalgamation of all of the great mentors I’ve had over the years. I definitely lean into patient-centered care, high-value care, and evidence-based medicine. I would rather a learner think about the why behind what they are doing than to “get the answer right.” I also try to utilize all of our resources – if child life or nursing has a suggestion, take a minute to ask them to teach you or explain. The residents at UTSW taught me a lot about keeping the fun and humor in medicine, which makes us all more willing to learn! And lastly, I think helping out learners when it is busy or stressful (by discharging a family before rounds or writing that H&P yourself) allows them a chance to absorb the teaching better.
4. At PHM 21, you co-led a great talk on subcutaneous rehydration therapy. Can you tell us more about the patients that benefit from this treatment? And how do you explain it to patients and parents—are they usually receptive?
I wish we offered it to families more! UNC sees a very large number of complex patients, often resulting in difficulty obtaining IV access. Our emergency room started using SCRT years ago very effectively and we now use it about once a month, with hyaluronidase. It is ideal in patients where IV access is challenging and an ND tube is contraindicated. A perfect example is a complex patient with a dislodged GJ tube who just needs overnight hydration until radiology can replace the tube in the morning. We also use it as a bridge to IV therapy as our nurses feel that it often “plumps up” the child’s veins, making access easier. It is important to prep the parents so that they know what to expect – you should see some swelling, it may look pink (not red), and is less painful than an IV (I made sure to have SCRT myself so I could honestly share my experiences with families). Most parents aren’t as shocked by the idea as you might think.
5. You are the program director of the PHM fellowship at UNC Children’s Hospital. How do you ensure autonomy and mentorship during fellowship training?
Great question and a great challenge. It is important to understand that fellows are not glorified residents. They are essentially new attendings getting a crash course in PHM and finding their own clinical and teaching style. It is actually harder to provide valuable feedback and autonomy to a fellow than to lead a team yourself, but it is way more rewarding. We try to provide fellows with the tools necessary to create a strong mentorship relationship – by setting expectations and having them come to the mentor with as much effort as expected from the mentor. Another great tip is to ask the fellowship administrator what individual might be a good mentor for the fellow. This is how I found my fellowship mentor because our admin knew what sort of personality and style I needed in a mentor and could identify the perfect individual.
6. With Drs. Rubenstein and Chase, you wrote “Things we DON’T Do for No Reason” in Hospital Pediatrics. Can you tell us where you came up with the idea? You discussed three examples but said “[we] encourage this discussion to continue, at conferences, meetings and break rooms everywhere.” Will there be future lists (or any ideas you can share with us)?
I always enjoy working with these two! The idea came from us venting about how sometimes we in PHM focus so hard on safely doing less that we forget about opportunities where doing more has been shown to be better. Jared Rubenstein (a genius in his own right, check out his youtube: https://www.youtube.com/watch?v=BbNi_-wYXJE) came up with the term “safely doing better,” which I love. Reducing unnecessary care is absolutely important, and I would not dare to imply otherwise. Along with safely doing less, though, we need to start identifying where additional care IS necessary and where our practice is lagging behind or not aligned with best evidence. In addition to the three examples in the paper, we also came up with a list that included things like early discussion of goals of care, contraception counseling in hospitalized patients, and catch-up immunizations for hospitalized patients. If anyone has any other ideas, I would love to collaborate on another article.
7. Jack Percelay often ends his list-serve commentary with the phrase “that’s just my 2 pennies.” What are your two cents?
Cent #1 – Listen to your nurses and include them in care plans/decisions. This has saved me numerous times over my career and also taught me so much. When I think back over my career, I have had the pleasure of working with some of the most compassionate, amazing nurses who have solved my diagnostic dilemmas or created solutions to patient care issues while we changed a diaper together or helped a patient get up to the restroom. Nurses are the most valuable tool a pediatric hospitalist has! I think we really need to think, as a PHM collective, about the role we have in combating the nursing shortage and nursing burnout.
Cent #2 - Denzel Washington once said, “Show me a successful individual and I’ll show you someone who had real positive influences in his or her life.” I am the product of many amazing mentors who saw possibilities in me that I didn’t see in myself (including running this website!). To those individuals, I want to say ‘thank you,” I am eternally grateful. I can only hope to pass that along to others in the future. Never underestimate the power of a good mentor!