1. Please share your most interesting case with a patient?
“My most interesting and memorable case would be during my Respirology fellowship at UBC. In my last year, I was on Respirology service with my mentor, who happens to be the local Interstitial Lung Disease expert. We were consulted in the ER for a male patient in his 40s, previously completely healthy, who was presenting with worsening shortness of breath, requiring oxygen quite acutely, and markedly abnormal chest x-ray and CT chest. His chest imaging and presentation suggested a rapidly progressive interstitial lung disease. When I saw the patient, he was already requiring several litres of oxygen via nasal prongs and progressing to respiratory failure, despite being a completely healthy person. On my physical examination, he had features of the shawl’s sign, mechanic’s hands, and eyes had a heliotrope rash. With these features, our preliminary diagnosis was progressive interstitial lung disease due to possible dermatomyositis. We immediately consulted Rheumatology and Dermatology for these skin findings to help secure a rapid diagnosis, so that we may initiate treatment as soon as possible for his lungs. Interestingly enough, both Rheumatology and Dermatology did not concur with our findings, and had a different much more common diagnosis for his skin. In discussion with my mentor, with the rapid deterioration in his lungs, we went with our “gut feeling” and treated him with our initial diagnosis quickly. The patient did require lots of oxygen and needed to be in ICU. There, a formal biopsy of his muscles were done, and this DID confirm our initial impression. Thankfully, because we initiated strong immunosuppressives right away, the patient did not require any mechanical ventilation, and slowly improved. This case was memorable because it taught me to trust my clinical skills and my judgement, even if others may not agree with your diagnosis. At the end of the day, the most important thing is my patient, and that I treated him to the best of my abilities!”
2. What is the best advice you were given during your time in medical school that has had a lasting impact on your practice?
“The best advice I was given during school, especially in the practice of Internal Medicine, is ‘when you hear hoofbeats, look for horses, not zebras…’ BUT…. as we are Internists, we can often find zebras, such as my most memorable case as above. So I was taught to trust in my clinical judgement, and have a practical approach to the practice of medicine, where usually there are horses, but be open to the possibility of zebras!”
3. What are you currently working on that is helping to impact our local medical community and/or local patients?
“I think that Ridge Meadows has an amazing Respiratory department, with excellent Respiratory Therapists and support staff, all of whom play a very active role in the management of airways disease such as asthma and COPD. Currently, the asthma and COPD clinic is run by our RTs only. I would like to incorporate having a Respirologist involved in the asthma and COPD clinics so that we can expedite the patient’s assessment and initiate therapy as soon as possible. I think that this multidisciplinary approach will be able to provide even better care to our patients with airways disease.”
4. What is some advice or wisdom you would like to share with your medical staff peers, or any new physicians joining our community?
“The medical staff at Ridge Meadows is an amazing team and has been very open to bringing in new initiatives that can impact patients’ care. I would encourage new physicians to feel free and ask if there’s anything unclear, or there’s interest in bringing something new to Ridge Meadows. The staff are all very open to discuss their experiences and opinion, which has certainly helped steer me away from a more difficult path.”