The patients are everything

I saw my first patient this week at the Montlake pulmonary clinic. A common question I've gotten here and from my prior UCLA colleagues is what my clinical footprint will look like here as someone who has been a very busy inpatient and outpatient clinician for most for my career. 

I will answer that question here for everyone:

• I don't have any clinical obligations in my role here, but I cannot fathom the idea of not seeing patients.
• My main goal for starting clinic now was to ensure that my patients at UCLA that have chosen to transfer have a place to go.
• My long-term goal is to build a rare lung disease program here with a focus on my academic/research/clinical niche, an orphan disease called pulmonary alveolar proteinosis (more about this later, hopefully at an in-person grand rounds).
• ICU medicine is my jam, and I'll keep a small inpatient clinical footprint if possible. 

Most importantly, I believe that I have to experience the UW medicine clinical environment from both the provider and patient perspectives in order to better understand how we can continuously improve the patient experience, clinical outcomes, and the many interconnected missions that define UW Medicine.

My long-term UCLA clinic patients that are following me (whether in-person or telehealth) will also be a great source of honest information about their own patient experience here. I can already say that they sit on hold longer with the call center here than they are used to. 

All of this will help me in my leadership role in the DOM but also as Associate VP of a new Office of Clinical Transformation for UW Medicine. OCT for short (since everything here is an abbreviation) will focus on improving the overall clinical efficiency and infrastructure in our healthcare system. This will take time, but I can already see many opportunities for improvement. 

Getting to continue seeing some of my long-term UCLA outpatients has actually been comforting to me — in some ways making me feel a bit less homesick. When I was leaving UCLA after >20 years, I knew it would be hard to say goodbye to so many groups - the ICU nurses (and their culinary skills!), the pulm division, our DOM work community, our home network of support. 

But I did not anticipate that the hardest thing to do would be saying goodbye to the patients — many private moments in clinic during my last few months where the patients and their families shed tears leading me to shed tears as we reflected on the trusting long-term relationship we all had together. 

This is not meant to make me sound like any kind of special doctor. But what I learned by leaving UCLA is the impact that physicians have on their patients everyday that they don't even realize. Even leaving my own doctors and dentist was one of the saddest things about moving. I know how easy it is to get caught up in the EMR and prior auths and all the busy work of being a clinician, but I hope you all know how much your patients depend on you and trust you. 

For me personally, my patients have also always been a source of support and joy. And they have taught me a lot about love and loss. During the early days of running the pandemic response, I was close to losing my mind until I went to clinic and saw that one of my outpatients had dropped off some flowers. 

Her brief message was this: "Take a moment to close your eyes and smell the roses; it will come to an end." I did not know it at the time, but it was absolutely what I needed on that stressful day — I paused, took a deep breath, and found the strength to keep going.

Mid-pandemic I lost one of my dearest outpatients ("Mi Amor") and in the midst of that sorrow, I wrote about her in my journal and later showed it to my journalist sister-in-law. 

UCLA Magazine coincidentally was in the midst of highlighting the pandemic response and pulmonary/critical care workforce and they published this story in 2021 and later turned it into a short video. 

In the clinical research world, with the help of the wonderful pulmonary clinical trials team and pulmonary extraordinaire Dr. Bridget Collins, we were able to launch a clinical trial here at UW this past week for pulmonary alveolar proteinosis patients. 

This practically means that two PNW patients who have been travelling all the way to Los Angeles every 3 months for study medication can now get their care locally! Bridget is also slated to enroll a new patient this coming week, a young oxygen dependent gentleman in his 20s who has had to undergo multiple procedures just to be able to breathe. I'm optimistic that we will be able to improve his quality of life soon! 

This is the beauty of academic medicine and I'm so happy to be here and continue this work with some amazing colleagues. 🙂

Hope everyone is having a wonderful summer,
Tisha

PS: In LA Laika was an airplane dog but here she is learning how to be a boat dog!