Op-Med is a collection of original articles contributed by Doximity members.
Name: Diana Finkel, DO
Specialty: Internal Medicine, Infectious Disease
Education: Med-KCUMB Res/Fellowship-St Michaels Medical Center/Seton Hall
Areas of Expertise: HIV/HCV, General Infectious Disease, Hospital Epidemiology
Current Position: Assistant Professor of Medicine, Division of ID, NJMS Rutgers Newark
1. Why did you choose Internal Medicine?
I chose medicine because I wanted to help others and be able to learn something new all the time. I chose infectious diseases to be able to work with patients with HIV. My first conscious awareness of HIV was when I was a sophomore in college, driving with my friends to get Chinese food, and Magic Johnson announced on the radio that he tested positive for HIV and that he was infected through heterosexual contact. That is when it really registered with all of us that we may be at risk. It remains one of the most formative moments of my career.
2. What area of your specialty is changing most rapidly?
The ability to eradicate HCV almost universally through a short course of easily-tolerated oral medication is a revolutionary development in Hepatitis C care.
3. What is the last journal article or piece of research that significantly changed your practice?
I was shocked to see CDC data that young African American MSM have 1:2 risk of lifetime HIV infection. I was also tremendously impressed with studies of at-risk populations that PREP (with tenofovir/emtricitabine) can lower risk by 92–99% when taken every day. For the first time, we can offer uninfected patients a self-controlled, effective, oral option to help them decrease their chances of becoming HIV infected.
4. What are your research interests?
I am currently interested in the use of telemedicine in implementation studies of PREP and HCV care. We are particularly focusing on use of video conferencing in partnerships of academic and community providers to increase implementation of PREP and the use of telemedicine in addiction services and linkage to HIV and Hepatitis C care.
5. What are you learning now?
We are trying to figure out how to provide bridging addiction services to people hospitalized or incarcerated for drug-related issues to community medical services. The opioid epidemic has caused tremendous morbidity and mortality in young adults, and better modalities of treatment and retention in care are desperately needed.
6. Outside of your daily practice, do you have any personal or professional projects that you’re passionate about?
To be able to better take care of all my transgender patients’ needs, I have also begun providing gender affirmative care as well as primary care and PREP and HIV care if needed. I believe that treating the whole person, being a patient’s medical home is ideal for the well-being of the patient and necessary to improve retention in care.
7. What is a common misconception that other clinicians or the general public have about infectious diseases?
ID issues carry a stigma — in the hospital setting, the cardiologist comes in and says he is there for your heart, the pulmonologist comes in and says she’s there for your lungs, then we come in, and the roommate of our patient wants to know if they should be in a different room. Infectious disease is a universally-needed specialty — not just for sexually transmitted diseases or exotic infections.
8. What is the best advice you have ever received? The worst?
Best: Remember that as physicians, you are not trapped — the job you have is for now, not necessarily forever. If you do not like the job or field you are doing, you can find a setting in medicine that suits you better. Worst: don’t get too close to your patients–sick patients die and you will be hurt.
9. What has been your most gratifying moment of being a clinician?
Seeing my HIV positive patients get married, have HIV-negative children and raise families — have those normal lives they thought they would never experience.
10. Complete this sentence: I start each day by telling myself…
I am lucky to be able to make a living by helping others.
11. How do you motivate your patients to do what’s best for their health?
I try to share with them data that show tobacco and obesity both decrease life expectancy by 10 years. We also do “success dances” together when the patients reach their care goals.
12. What is the biggest challenge or obstacle in your specialty?
Trying to stop the cycle of overuse of antibiotics and increased drug resistance in infectious pathogens.
13. At the start of your career, what do you wish you had known? What, if anything, do you wish you had not believed?
I wish I had known that one day we would be able to prevent HIV with one pill a day. I wish I had not believed that we would always have plenty of antibiotics to fight any infection.
14. When in your career did you feel most despondent and what did you do to turn it around?
I felt overextended during my last few years in private practice — constant call and managed-care paperwork, with less time to read, learn, and spend time with my family. I chose to go back to academic medicine even though it meant making a significant change financially.
15. Do you do anything special or have any unique hobbies or interests you’d like to share?
My son and I went on a plant-based diet a year ago in an effort to decrease our risk for metabolic and neoplastic diseases. So far, I am sticking to it!