By Admin | February 20, 2008
Dr. Tony Slonim is a practicing pediatric intensivist, an expert in the study and prevention of medical errors, and a senior healthcare executive. His new book Avoiding Common Pediatric Errors will be published next month by Lippincott Williams & Wilkins. We recently had a chance to speak with Dr. Slonim.
Where are you from?
Originally, from New Jersey, but most recently, I’ve been in the Washington DC region for 12 years prior to moving to Roanoke, Virginia last April.
Where did you go to college and what was your academic major?
I went to NYU. I had a double major in economics and psychology.
You have a nursing degree as well as a medical degree. Why did you decide to become a nurse? Where did you work?
I have always really enjoyed clinical work and wanted to assure that I could professionally care for patients even if I wasn’t successful in getting into medical school.
I enjoyed nursing school very much. Nursing is a great profession and physicians need to have an appreciation for the work that nurses do and their contribution to patient care as a critical member of the healthcare team.
I worked for 3 years at the Mountainside Hospital in Glen Ridge, New Jersey as an emergency department nurse. It was a great opportunity for me to be able to care for patients as both a nurse and a physician in my carerr.
I learned that patients treat their providers very differently. Patients are very formal with their physicians, but will joke around and tease nurses in a way that makes the work very rewarding. I still miss some of the experiences that I had as a nurse.
What was your career path from the end of medical school to your current position?
After medical school, I wanted to open up a private practice near my home town and care for families. I did a combined residency in New Jersey at St. Joseph’s Medical Center in Internal Medicine and Pediatrics.
It was a great experience for me. I couldn’t have selected a better program for my training experience. It was very hands on. Unfortunately, I spent so much time in the ICUs that I actually felt out of place in the office setting and much more comfortable in the ICU setting.
So, I applied to and was accepted in fellowship training at NIH in a combined med-peds critical care fellowship. I received my pediatrics experience at DC Childrens.
My research was focused on healthcare quality and ICU outcomes. I was fortunate in finding a faculty position at DC Childrens after I graduated and remained there until 2007 in a variety of roles related to the administrative side of medicine, specifically focused on medical performance, quality and patient safety. This overlapped nicely with my emerging research interests in quality, patient safety, and medical errors.
Last year, I accepted a position at the Carilion Clinic as the Vice President of Medical Affairs at Carilion Roanoke Memorial Hospital, an 850 bed academic medical center in Roanoke Virginia.
In this role, I help to oversee the provision of quality healthcare with an amazing team of individuals focused on assuring that our community receives the best medical care they can. I continue to write and perform research, since these are two of my personal passions.
You were the Vice President of Medical Affairs at the Carilion system for four days when the tragedy at Virginia Tech happened. How did you hear of the tragedy and what were your initial thoughts when you heard the news?
The Virginia Tech incident was a terrible tragedy for our community and in many ways for our nation and world. There is supposed to be fun and excitement associated with the pursuit of higher education and none of us expects such tragedy to arise on a college campus.
We were notified on the morning of the incident and immediately prepared for the worst. Like any other trauma center, our teams and resources kicked into high gear to assure that we were prepared to handle any victims. Unfortunately, many victims died on the scene and never reached us.
What are the two biggest problems in healthcare today?
I think that currently the two biggest problems are one of value and mis-allocation.
First, I’ll discuss the value issue. As a wealthy country that spends an exorbitant amount of resources on healthcare, we should be realizing healthcare outcomes that are the best in the world. Unfortunately, this is not the case.
I believe healthcare quality and efficiency can be improved so that patients receive healthcare of greater value. I believe in this for my own organization and I believe that more broadly through quality research and publications, we might be able to help others accomplish these goals too.
Second, I am concerned about the misallocation of care in this country. While we have certain areas where there is waste, this is contrasted with pockets of maldistribution of providers and lack of fundamental healthcare services. These inequities should not be allowed to continue to exist.
What would you say to a college senior who said “I just got into both Harvard Med and Harvard Law. Do you have any advice for me?”
I believe that career choices are a very personal experience. Rarely do you know why or how you come to a certain career decision.
I’ve never been an attorney, so I don’t know how rewarding that profession might be. For me, medicine is something I’ve wanted to do since I was in grammar school…a calling of sorts, although that sounds very cliché.
Despite the opportunity I get to contribute broadly to caring for populations of patients through my writing, research and administrative work, the biggest personal satisfier for me is caring for a critically ill patient and their family in the ICU.
Despite all the first authored papers, books and grants, the thank you notes from my patients hold the most special place for me in my professional life.
Being a physician for me is a privilege. It something I always wanted to do, but wasn’t sure that I would be able to achieve. So, I treasure every moment I have in this profession. It is pretty interesting.
Approximately five years ago, I had a serious illness and saw healthcare from the other side of the bed. I never would have realized just how attached a patient could be to their providers.
I was so appreciative of not only the medical care, but also the compassion and warmth exhibited by so many members of my clinical team for what could have been a disastrous life event for me and my family.
Why have medical errors not really decreased since the landmark 1998 study by the Institute of Medicine?
With all of the attention and all of the press around medical errors, I think that fundamentally, the system is designed incorrectly and will continue to lead to outcomes that fail to meet our expectations.
In order to be successful at improving healthcare in America, we need to reexamine the things we’re doing and assure they add value to the healthcare experience.
Patients are sicker, providers are working harder than ever, our incentives are misaligned and our patients are not getting the care they deserve. To some extent, I believe we need to start with a clean slate.
You have written several medical textbooks, Which is your best one and why?
I have been fortunate in being able to participate with some great people while writing my textbooks. Each book really helps me to learn new things about the practice of medicine and about myself.
I am very proud of several categories of books I’ve written. The first category is aimed at helping physicians study for board examinations. I have published approximately five books in this category aimed at internal medicine candidates, pediatrics candidates, and critical care candidates.
The second category is aimed at helping doctors to be better doctors. This is work that we’ve collaborated on for the Common Medical Errors Series. I will have published three books in this category aimed at helping clinicians perform better.
It is quite a privilege to be able to help patients ‘remotely’ by contributing even in some small degree through the education of our colleagues, fellows, residents and students and I take great pride in that work.
I hope that maybe over the years I might have contributed a clinical pearl or nugget to another provider that was able to be used to benefit a patient.
Finally, the third category is the textbook I wrote with Murray Pollack called Pediatric Critical Care Medicine. This work was a core textbook in the discipline of pediatric critical care medicine and was certainly the most challenging project I’ve been involved in with over 120 contributors and the opportunity to frame the state of practice for this discipline.
What one thing in your career would you do over again if you had the chance?
Things fall into place for a variety of reasons. I would have never planned to go the route I went through my schooling and education, but it certainly has worked out well for me and provided me with insights and an opportunity to view the world and be informed with a variety of different lenses, which contributes to my work on a daily basis.
What innovations are you trying to implement in the Carilion System?
I accepted the position at Carilion because of the outstanding leadership team and the dedication of that team to the community we serve.
For me, healthcare and public health are very important principles. I believe that if we’re successful, every individual patient and family will feel as though they’ve been treated with the best that US healthcare has to offer and that the care for the populations and communities we serve will actually improve.
To that end, our approach to caring for patients is fundamentally different. We have a number of physicians in leadership roles and they are paired with administrative partners who work as dyads to both understand and improve the way care is delivered for patients in our communities.
I believe that this will allow us to focus on things that are important for our patients’ outcomes and deliver on results.
What motivates you to get out of bed in the morning?
The feeling that today I might make a difference in someone’s life and make them feel as though the care they or their family member is receiving makes them feel as though they are the most important person in the world.
Disclosure: the interviewer has collaborated on several book projects with Dr. Slonim
Copyright 2008 DailyInterview.com
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