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Join us in this episode as we sit down with Janet A. Jokela, an internal medicine and infectious disease physician. Janet reflects on her transformative residency at Boston City Hospital, where the “city savages” thrived in the face of immense challenges. We discuss how the intense training shaped her career, the evolution of internal medicine, and the enduring commitment to compassionate patient care.

Janet A. Jokela, MD, MPH, ACP’s Treasurer 2022-2025, served as the Regional Dean of the University of Illinois College of Medicine-Urbana, and currently serves as Professor and Senior Associate Dean of Engagement at the Carle Illinois College of Medicine, Urbana, IL.

She discusses the KevinMD article, “Internal medicine physicians: leaders and the foundation of comprehensive health care.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome back Janet Jokela. She’s an internal medicine and infectious disease physician and the treasurer of the American College of Physicians. Today’s KevinMD article is “Internal Medicine Physicians, Leaders, and the Foundation of Comprehensive Health Care.”

Kevin Pho: Janet, welcome back to the show.

Janet Jokela: Thank you so much, Kevin. Delighted to be here.

Kevin Pho: It’s always wonderful to hear your perspective and wisdom. Tell us what your latest article is about and the events that led you to write it in the first place.

Janet Jokela: Yeah, great. Thank you so much. And I’m just so pleased to be able to share my story with you and others. Here’s the thing—later in October, it’s Internal Medicine Day. I started thinking about what that means and where I really learned what it meant to be an internal medicine physician and how to do that. It brought me back to residency. So this article is a bit of reminiscing and just brought back a whole bunch of fond memories.

Kevin Pho: In this article, you talk about your time at Boston City Hospital. I think we talked offline, and some of my listeners know I went to medical school and did my residency at Boston University. I did my residency at Boston Medical Center, which used to be the Boston City Hospital, and I have fond memories of my own residency days. So for those who didn’t get a chance to read your article, tell us about some of those memories.

Janet Jokela: Yeah, so I started to think about where I became a physician and where I learned what it meant to be a physician. I realized it was all in residency. Long story short, I was coming from the Midwest, and I was interviewing for residencies in the Boston area. I remember going to a prestigious Boston hospital. It was all very impressive, very nice. I remember asking the chief resident on that tour a few questions, including a quiet one saying, “Well, what do you think about Boston City Hospital?” And he immediately responded, saying, “Those residents are angels. I don’t know how they do what they do, but they are amazing.” Unbeknownst to him, he sold me on the program—not on his program, but on Boston City.

Kevin Pho: For those who aren’t familiar with Boston City Hospital, now called Boston Medical Center, just give us a sense of the neighborhood it’s in, the patient population it serves, and what makes that place so special.

Janet Jokela: Right, right. Delighted to do that. I have such fondness for Boston City; it’s not funny. It’s in the South End in Boston. It’s in the city. You drive along Mass Ave, going toward the ocean and I-90. Or was it I-93?

Kevin Pho: I-93?

Janet Jokela: OK. And there it was. It serves the underserved in the city of Boston: people without insurance, people who don’t speak English, people who may be employed but don’t have insurance or are underinsured. It’s all walks of life, and it was really a pleasure to be there—a hard place to work. People came in with the ravages of alcohol use disorders, substance use disorder, hepatitis. At that time, we called it non-A, non-B hepatitis—that dates me, and that’s OK. We dealt with all of that. It was a challenging place to work but incredibly fulfilling at the same time.

Kevin Pho: So, you came looking for a residency. You graduated from medical school and didn’t have a lot of clinical experience. Tell us about some of the stories that really turned you into the internal medicine physician that you are today—stories that you learned from Boston City Hospital.

Janet Jokela: Oh, gosh, how much time do we have, Kevin? We could chat for hours. I do share a number of these stories with our current students today as they’re thinking about what direction to go in with their careers. One particularly fond memory that inspired me was—at the time, I believe I was an intern—one of the second-year residents’ jobs was to work and supervise in the ICU overnight. He was all by himself; there were no attendings in the hospital at that time. The entire lab in the hospital went down, and he had a patient in the ICU with renal failure and hyperkalemia. He followed the patient’s EKG and the T waves, and that’s how he monitored the effectiveness of his treatment. We heard it at Morning Report the next morning, and we were like, “Oh, wow.” We were just so impressed and so proud that he thought to do that. We would go to any lengths to deliver the best possible care to our patients because they deserved it, no matter where they came from or what was going on.

Kevin Pho: In your piece, you coined a nickname: “City Savages.” Tell us more about that nickname.

Janet Jokela: Our residency program director said, “You guys are City Savages.” And we thought, “What are you talking about? What do you mean?” He reminded us repeatedly—and I came to experience it—that by the time you’re a third-year resident, we can take care of anything. Any challenge that comes in the door. We were running codes throughout the entire hospital, the medicine resident, the surgery resident. The consult service—we would go to all the codes. We took care of the radio in the emergency room. We would provide instructions to all the EMTs coming into the emergency room over the radio. We took care of everything. We were really in the depths of all these details, of all these really sick and complicated patients. We could take care of anything, and we were proud of it. Our residency program director was also really proud of that. That’s where the whole nickname, City Savages, came from.

Kevin Pho: Now, you’ve seen the evolution of residency programs, and I’m sure a lot has changed since your time in residency. Now there are more structured schedules, closer supervision, and work-hour restrictions. Talk about some of that evolution in residency compared to what you were experiencing at Boston City Hospital.

Janet Jokela: Right. We were incredibly proud as residents with all that we could do. In hindsight, we were relatively unsupervised. And, in the big picture, that’s probably not optimal for the top-notch patient care we so much want to deliver. So today, with those changes and some of the things you mentioned, including the advent of hospitalists and Electronic Medical Records, many of those changes and improvements were really designed to improve patient care. I think that’s true. I mean, I think that’s all happened. Those are all important changes and evolutions in medicine. I’m fond of the training we received, but at the same time, patient care has improved over the ensuing years, and that’s a really wonderful thing.

Kevin Pho: So I want to talk about the influence your residency experiences have outside of clinical medicine. Let’s say when you’re teaching fellows, residents, and medical students. How has your training at Boston City Hospital influenced your teaching style today?

Janet Jokela: Oh, Kevin, again, it’s all about stories and sharing our stories. When working with students and residents, I try to share stories about the EKG instance or other times when we faced challenges. We want to instill the same commitment, compassion, and devotion to patients from all walks of life who deserve and warrant the same level of excellent care as anybody else. It’s those kinds of points and issues that we try to share with students and residents to ensure we’re all on the same page and delivering excellent patient care.

Kevin Pho: You mentioned earlier that a lot of your clinical training was relatively unsupervised. On the flip side, it gave you a lot of independence as a resident. Did that independence during residency contribute to you now as a physician leader?

Janet Jokela: It’s an interesting point. In retrospect, it may seem like we were unsupervised as residents at Boston City. But I think the teaching was so excellent and the clinical instruction so good that if any of our attendings ever thought we were a risk to patients, we wouldn’t have been permitted to do what we did. And I do want to mention the nurses. The nurses watched us like hawks. If we screwed up, caused problems, or anything else, the nurses would let us know and also be in touch with the attendings. So while it may seem like we were unsupervised in many ways, there was a structure around us. Today, things are much more structured than they were, and that’s good. I give students and residents space to articulate what they want to do and why they want to do it, and then I gently correct or guide as needed. That independence is important today; it’s just more structured. And that’s OK.

Kevin Pho: Historically, internal medicine physicians are detectives. We’re problem solvers. You told that story about the resident who solved the hyperkalemia problem overnight in the ICU. With a lot of the administrative burdens, prior authorization, and obstacles preventing physicians from having that time and space to solve problems, do you see that role as a problem solver changing today?

Janet Jokela: Great question. I don’t think it’s changing. In people’s hearts and souls, this is who we are. We take care of complex patients longitudinally over a long period of time. We solve problems. We’re disease detectives. We’re expert diagnosticians. That doesn’t change. There are external pressures that complicate things and create moral injury and tension between knowing what we need to do and our time being squeezed in other directions. So, it doesn’t inherently change what we want to do or who we are. It’s just more challenging than it used to be.

Kevin Pho: How can we overcome those challenges? How can we continue to be problem solvers despite those challenges?

Janet Jokela: One of the most important ways is advocacy. The American College of Physicians, in particular, has a really strong advocacy team, and there are so many physicians and leaders within the college who participate in that. We have an annual Leadership Day in Washington, D.C., where we talk about these issues with our congressional leaders. Even beyond that, the ACP is doing work on prior authorizations and physician payment reform. It’s all geared toward protecting the internal medicine profession and ultimately to take better care of patients. That’s why we’re here.

Kevin Pho: If you were to repeat your medical career all over again, now that you have time to reflect on it, would you do internal medicine again? If so, tell us why.

Janet Jokela: Yes, absolutely. I would do it again at Boston City—the Boston City that was, of course. I loved it. I loved taking care of patients longitudinally, getting to know their concerns, issues, and families. I absolutely would have done it again. The diagnostic challenges are exciting, and you’re always learning and growing. Taking care of complex patients over time is a real privilege. Internal medicine physicians are leaders—they lead within clinical settings, health care, and medical schools all over. It’s a wonderful opportunity to put those skills to good use.

Kevin Pho: For medical students listening, what questions should they ask themselves to decide whether internal medicine is the right career path?

Janet Jokela: The first thing to consider is whether they want to do procedures or not. That can help divide their thinking between a surgical route or a non-surgical route. Internal medicine offers many opportunities to do procedures in GI, pulmonary, or cardiology. Beyond that, it’s about focusing on diagnostics, being an expert diagnostician, taking care of patients over the long term, and seeing the big picture. That’s what makes internal medicine so incredibly rewarding.

Kevin Pho: Janet, as always, let’s end with your take-home messages for the KevinMD audience.

Janet Jokela: The future is in good hands. The medical students I see at the Carle Illinois College of Medicine and around the country are deeply compassionate and committed to taking excellent care of patients. They are also committed to changing medicine for the better. Medicine is in good hands, and I’m so proud and grateful.

Kevin Pho: Janet, as always, thank you so much for coming back on the show and sharing your wisdom, insight, and perspective.

Janet Jokela: Thank you so much, Kevin. Delighted to be here. Good to see you.