Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!

Join us for an insightful discussion with Moksha Patel, an internal medicine physician, as we explore the fascinating parallels between clinical reasoning and photography. Moksha shares how principles like focus, zoom, and flash in photography can enhance medical practice, offering unique perspectives on diagnosis, patient care, and maintaining the human connection amidst the demands of modern medicine. Discover how cross-disciplinary skills can enrich clinical reasoning and why creative pursuits outside of medicine are crucial for clinicians.

Moksha Patel is an internal medicine physician.

He discusses the KevinMD article, “How photography made me a better doctor.”

Our presenting sponsor is Nuance, a Microsoft company.

Do you spend more time on administrative tasks like clinical documentation than you do with patients? You’re not alone. Clinicians report spending up to two hours on administrative tasks for each hour of care provided. Nuance, a Microsoft company, is committed to helping clinicians restore the balance with Dragon Ambient eXperience – or DAX for short. DAX is an AI-powered, voice-enabled solution that helps physicians cut documentation time in half. DAX Copilot combines proven conversational and ambient AI with the most advanced generative AI in a mobile application that integrates directly with your existing workflows. DAX Copilot can be easily enabled within the workflow of the Dragon Medical application to bring the power of ambient technology to more clinicians faster while leveraging the proven and powerful capabilities used by over 550,000 physicians.

Explore DAX Copilot today. Visit https://nuance.com/daxinaction to see a 12-minute DAX Copilot demo. Discover clinical documentation that writes itself and reclaim your work-life balance.

VISIT SPONSOR → https://nuance.com/daxinaction

SUBSCRIBE TO THE PODCAST → https://kevinmd.com/podcast

RECOMMENDED BY KEVINMD → https://kevinmd.com/recommended

GET CME FOR THIS EPISODE → https://kevinmd.com/cme

I’m partnering with Learner+ to offer clinicians access to an AI-powered reflective portfolio that rewards CME/CE credits from meaningful reflections. Find out more: https://kevinmd.com/learnerplus

Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast, and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Moksha Patel. He’s an internal medicine physician. Today’s KevinMD article is “How photography made me a better doctor.” Moksha, welcome to the show.

Moksha Patel: Thanks, Kevin. Thanks for your work and for sharing our stories every day.

Kevin Pho: All right. So let’s start by briefly sharing your story and journey.

Moksha Patel: Yeah, so my story and journey is long and winding, to be honest, but I’ll give you the one-liner. I actually have severe OCD and have had it since I was a child, which ultimately required brain surgery to fix and treat. But while there are several podcast episodes about that out there, the reason I bring it up is, it really shaped my interest in psychology, which led to my journey to eventually, as an undergrad, when I studied psychology, I studied under a professor called Dean Simonton, whose area of expertise was creativity and genius. And he didn’t care what field the person was a genius in, he just wanted to understand that the person was a genius and what made them that.

And at that time I became fascinated by how we could take lessons from one field and move them to another field. And that’s ultimately what inspired this article, about how photography, and passion in photography, could lead me to hone my skills in medicine, this kind of cross-training philosophy.

Well, fast forward many years and many steps on the journey, I fell in love with internal medicine. I’m now an assistant professor of hospital medicine at the University of Colorado, and I wear a lot of non-clinical hats. I do some clinical informatics, and I’m assistant director of mentorship for the OCD program. And recently, to try to explore outside of medicine, I actually created my own mobile game online called Outwit AI, to try to learn about skills in computer programming and how those can translate over to clinical medicine.

Kevin Pho: All right, wonderful. And I think medicine is one of those fields where there are so many interdisciplinary intersections, and I’ve talked to so many physicians on this podcast, they’ve written of course on KevinMD, and it’s so fascinating to learn some of their skills outside of the exam room or outside the hospital.

Moksha Patel: Totally, yeah. No, I feel like the art is long and life is short, and the only way to perfect it is to constantly, deliberately practice.

Kevin Pho: All right. So you’re going to talk specifically about “How photography made me a better doctor.” For those who didn’t get a chance to read your article, tell us what it’s about.

Moksha Patel: Yeah, so I started taking photography in high school as one of our required classes, and at that time they teach you a little bit about a few elements of taking a good picture. And some of the things, as I was doing clinical reasoning and cognitive reasoning in the clinical space, I really noticed some similarities.

One of the major ones being your focus. What you focus on, which objective data or subjective data you focus on, can really change your entire problem representation and your one-liner.

Zooming in and out, like sometimes as an intern, I remember getting caught up in details, and then I would have a more experienced attending or resident come in and say, like, hey, let’s zoom out for a second, what is our big picture thing here? This person is 90 years old, has end-stage cancer, you’re worried about their sodium being 133, is that really that important right now, or are we worried about goals of care, et cetera? And so that zoom feature in photography.

And then my favorite one is the kind of nebulous flash. We add flash to a picture whenever it’s dark and you need to add some light to it. And I have learned to add flash to everyday interactions with patients, especially when they come in with something quote unquote mundane, like COPD or asthma, that I’ve seen thousands of times, and try to connect with them on a personal level, to try to make this a little bit more of a human interaction than just an interaction.

Kevin Pho: So tell us a story where you added that flash. So like you said, you are a hospital medicine physician, and I’m sure you’re very busy and have all these metrics to meet, notes to write, and sometimes that takes away from that personal interaction that you have with patients in the hospital. Tell us a story and example where you connected with that patient and added that proverbial flash.

Moksha Patel: Oh yeah, I’d love to. So I was on service a couple weeks ago, and we had a patient come in, she was very young, mid 20s, come in with weeks of weight loss, fevers, chills, erythroderma, and also skin breakdown with staph bacteria, and ended up having newly diagnosed lymphoma. So she was understandably very anxious.

So I spent some time just trying to go through, I actually created a mnemonic for this, it’s called COLOR, add color to my workday. So C is for connection, so I asked her some questions about the type of music she likes, the type of dogs she has, those kinds of things. The first O is gratitude, so trying to be grateful for things in my life as well as for my colleagues’ lives. The L stands for laughter, so I try to have scheduled laughter at some time during the day and do jokes with my team. The other O is for curiosity, and I got very curious with her case and thinking about causes of erythroderma. And then R is relax, and taking scheduled breaks.

So with her specifically, that connection came with talking about dogs, which is always a great topic, my dog, who is no longer with us, but also her four dogs. And we connected, bonded based off of that, and I think she really trusted me a lot more after that encounter than before.

Kevin Pho: Now, I think that as hospital physicians you’re always pressed for time. How do you find that time to balance maintaining or establishing that personal connection with everything else that you have to do clinically?

Moksha Patel: Yeah, that’s a great question, and I’ll be honest, it doesn’t take as much time as I thought it would. It can be a simple question of, like, oh, what type of music do you like, or what type of foods do you like? And the person completely changes their perspective from, oh, this person only cares about whether I’m having bowel movements and my pain, to, oh, this person cares about me as a human. So it really only took me 20 to 30 seconds to talk to her about dogs and which breeds of dogs she had, and then we moved on with things, and it did not really add a whole lot of time to my day.

Kevin Pho: So I want to get back to that concept of zooming out that you had mentioned earlier. And I honestly think that skill of zooming out and picking out what’s important from what’s less important at times really is the mark of an experienced clinician versus someone that’s just starting out. So let’s say you have medical students and residents and interns rounding with you, and they’re confronted with a fire hose of information. How do you teach them to zoom out? How do you get them to focus on what’s important when they’re overwhelmed with all this data about a specific patient?

Moksha Patel: Yeah, I have two techniques that I have stolen from other people, so I’ll give them credit. One was my co-resident Byron Crow, who I went to residency with, he’s a hospitalist now as well. But he would always put things into buckets of, what needs to happen right now, what needs to happen by the end of the day, and what needs to happen before discharge. And so thinking of things in those types of buckets, of which of these problems need to be addressed right now, within the next few hours, and which needs to be addressed in the next few days, as one helpful technique.

And then the other one I tell people, I do a lot of nights, and so when I’m cross covering on nights, I ask the students, if you showed up to a rapid response at this patient’s bedside, what is the bare essentials that you want to know, so you can make educated decisions without knowing all the excessive things about smaller things? So when you show up at that room, what do you want to know so you can have clinical judgment as to how to approach this patient?

Kevin Pho: Oh, fantastic advice. So it’s been decades since I’ve stepped foot in a hospital doing clinical rounds. I’m an internal medicine primary care physician, we have hospitalists like yourself take care of our inpatients. How has hospital medicine evolved over the last 5, 10 years or so? Tell us about some of the challenges that you guys are facing today.

Moksha Patel: Yeah, challenges, and I’d say also opportunities. I think one of the major challenges has been, sometimes in hospital medicine we are tasked, as you guys are in primary care as well, to fix society’s biggest issues, a lot of social determinants of health.

In the last 5 to 10 years, I think with people not being able to care for their wounds because they’re unhoused, things that our system is not frankly set up to really combat, so you have these people who stay in the hospital for 90 days, 100 days, because we’re trying to figure out a safe disposition plan, and oftentimes there is not an ideal disposition plan because of the way society is set up. That is one of the biggest challenges I foresee, and trying to work in, how do we coordinate with society and governmental infrastructure to help people get the care they need outside of the hospital?

But I will say COVID, it was one of the very challenging times for us, as we were kind of right there on the front lines with a lot of illness and death, quite frankly. And what I learned, though, was that hospital medicine is really cool, and you get to be at the forefront of basically everything. Like, we started doing more critical care during COVID, once the critical care needs stepped down we started doing more floor patients, and we can do administrative stuff, we can do QI, informatics, the list is endless.

So I feel like hospital medicine, just by nature of being on the forefront, and kind of your gemba, I forget how to say it in QI words, is kind of walking the walk. And so I feel like it’s a very helpful place to be.

Kevin Pho: So tell us more about your photography background, and how is that important, not only in terms of influencing how you practice medicine, but as a creative outlet to have a passion outside of clinical medicine?

Moksha Patel: Yeah, I love that question, because I think anytime you can create a passion outside of medicine, it helps with that C of the COLOR, the connection with people, but it also helps just hone your skills and deal with things like burnout and other things.

So for me, I just got back from a trip to London, visiting my grandma for her 90th birthday. And London is a beautiful city, and so lots of amazing architecture to take photography of. And you start noticing, like, hey, if I take this picture at this angle, the reflection of this building will shine on this building. And you just see things a little bit differently. And I am by no means a pro photographer, or very talented at it, but that has been really quite fun to just explore, and like you said, have a creative outlet.

Kevin Pho: So what about your other physician colleagues? Do you see them having creative outlets outside of clinical medicine as well?

Moksha Patel: I do, I do. I have a couple friends who are actually much more skilled photographers than me, and they actually sell some of their photography work. I have another colleague who is a storm chaser, and actually chases storms and takes pictures and does an amazing job there. One of my other colleagues who just joined our group is learning to play the piano and is pretty good at it. And so there’s a lot of the arts there.

I’m sure there are people who do other, more scientific things. We’re in Colorado, so everyone practically is an outdoorsy hiker, skier, snowboarder, you pick it. I really am not, to be honest, but so there’s a lot of exploring that way too. And I feel like it’s been such a good cultural thing for me, to have a place that’s well balanced with different diversity of talents and diversity of interests.

Kevin Pho: So what about in medical students and residents? Because they’ve just been working and studying all the time. Are you seeing that they’re balancing well, and trying to balance what they’re doing clinically and passing all these boards and shelf exams with something outside of clinical medicine? What are you seeing from our younger cohorts?

Moksha Patel: You know, I think it’s getting better than, from what I imagine it was 20, 30 years ago, because I think schools are recognizing the importance of this kind of well-rounded clinician.

And so, the reason, I just did a podcast episode with one of the first year medical students who just started her own podcast, and so she’s now exploring how to be a podcast interviewer. We were the first episode, so we’ll see how it goes. But she had this passion and she wanted to explore it. So I’m seeing that medical students, I think more than at least when I went to training seven years ago at Northwestern, I think there’s a little bit more interest in balancing other things, and I think definitely more than maybe if you go back 20, 30 years.

Kevin Pho: We are talking to Moksha Patel. He’s an internal medicine physician. Today’s KevinMD article is “How photography made me a better doctor.” Mo, as always, we’ll end with some of your take-home messages that you want to leave with the KevinMD audience.

Moksha Patel: Yeah, I think my biggest take-home for the audience is, don’t underestimate the power of your personal passions in making you a better doctor. Because with those personal passions and interests, you can learn things that will make you a better clinician and help you better connect with your patients. And whatever that passion is, whether that’s creating AI generated art, or painting, or writing poetry, there’s a lot to be learned from these different fields and brought back to our field, which is a phenomenal field to be in.

Kevin Pho: Well, thank you so much for sharing your perspective and insight, and thanks again for coming on the show.

Moksha Patel: Thanks.