Making a Hematology Wishlist, and Checking it Twice

Happy New Year! Can you believe it’s 2017 already? Another holiday season passed, another calendar page flipped, another year gone by.

I thought that I was pretty good this year, earning a spot on the “nice” list, but Santa still didn’t leave all the presents I wanted under the tree. Here’s a sampling of gifts I asked Santa for this year (and didn’t get):

1. An empty Epic in-basket.
Who wouldn’t want a squeaky-clean Epic in-basket? But nope, I woke up on Christmas morning to find it full of messages from nurses, pharmacists, patients, and other providers, and much of the content in those messages had nothing to do with me or the hematologic issues of the patient I was being messaged about. Yes, it is nice to know that my patient who was treated for iron deficiency has a normal cholesterol level, but the notice is now something that I need to read and answer to clear out my in-basket. I’m starting to believe that I’ll never set eyes on that mythical “empty” in-basket.

2. A clinic day without a referral for a nearly normal blood count.
It’s not too taxing on the overstrained brain cells, and it can be a nice break from the complicated cases in which patients simultaneously bleed and clot. However, I contend that a nonagenarian with a platelet count of 148,000 doesn’t really require a hematology consult, especially when the patient is in a nursing home with terrible dementia and a broken hip.

3. A medical school class that doesn’t complain about small-group sessions at 8:00 a.m.
I’m the course director for the hematologic block at the University of North Carolina, which is now taught in the first year of medical school. Every year, our faculty receives multiple complaints about the unbearably early start time for our mandatory small-group sessions. Apparently, an 8:00 a.m. start time is a violation of the Geneva Conventions. Think I’m being hyperbolic? Here are a few of the comments I’ve received regarding the timing of these discussions:

“If she thinks small groups are important enough to be mandatory, then she should hold them in the afternoon when we’re awake.”

“There really is no need for small group to start at 8:00 a.m. every day. Many of us are still trying to adjust to waking up early and are still in that early adulthood sleep rhythm of studying late and waking up late.”

Really? I love it when I see these same folks as third-year students on their surgery rotations.

4. The complement cascade to be magically implanted into my cerebral cortex.
I know I make a New Year’s resolution to learn this set of pathways every year, and I really did try – several times, in fact. Yet, every time I get to “classical, alternative, and lectin,” my brain automatically shuts off. And how could it not? I read “lectins” and my brain gets confused and sees “lentils,” then I start thinking about black bean soup and … yup, another attempt to learn about complement is derailed. Maybe next year!

5. Not having to take the American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC) exam ever again.
I didn’t get this present this year and had to take the recertification exam in hematology in October, but, given the recent MOC shakeup, it might actually be waiting for me under the tree next year.

Assuming that I passed this year’s exam, then recertifying in the future might look really different: exams every two or five years, an open-book option, etc. Also, though I appreciate the attempts to test all of our knowledge, as a non-malignant hematologist, if I am ever placed in the position of having to choose a conditioning regimen for a patient undergoing a bone marrow transplant, then multiple things have gone wrong with our profession. I would welcome some of the proposed changes that would make the ABIM MOC process more relevant to our individual practice.

One thing I did get this year: a great group of colleagues and trainees at ASH and at my university. This is a present I get every year; it’s the gift that keeps on giving.

I hope you received a couple of items from your 2016 wish list, and I hope you have a great 2017! Time to start making the list for next year!