The Biggest Challenge in Gastroenterology? Keeping Up

Name: Adam Gluskin, MD

Specialty: Gastroenterology

Education: University of Pittsburgh Medical Center, McGaw Medical Center of Northwestern University, University of Illinois College of Medicine

Areas of Expertise: Colon cancer

Current Position: Gastroenterology, Hepatology, and Nutrition Fellow University of Pittsburgh Medical Center

1. Why did you choose gastroenterology?

As funny as this sounds, from the time I was in middle school I wanted to be a gastroenterologist. My father is a gastroenterologist and from an early age I would join him in the hospital from time to time and watch him perform procedures. I became fascinated by the technical aspects of the field early on. As I grew older, my interest in the field expanded beyond just this to an appreciation for the varied disease processes one gets to treat as well as the life-long relationships with patients you get to build in this subspecialty.

2. What area of gastroenterology is changing most rapidly?

I think there are a lot of areas changing rapidly. First off, the technology behind endoscopy is always changing and improving to increase our detection of things like colon polyps. Inflammatory bowel disease is another field that has seen lots of changes over the past few years as there has been a big increase in the number and types of drugs available. Lastly, hepatology has been revolutionized by the new hepatitis C drugs that have come out over the past few years and the next wave in this field will be anti-fibrosis agents.

3. What is the last journal article or piece of research that significantly changed your practice?

As a trainee, my practice is in a constant state of being refined. One recent guideline that stands out to me as something that changed how I approach a problem is the American College of Gastroenterology guideline on the management of dyspepsia from this year. A big change in this guideline is the recommendation to screen all patients with dyspepsia for H. pylori, not just those coming from high prevalence areas. In addition, the age to consider endoscopy for evaluation for new onset symptoms was increased from 55 to 60. Both of these were changes from prior recommendations.

4. What are your research interests?

I have a couple of areas of research interest. One of them is colon cancer screening. I first became interested in this area as a third-year medical student on my surgery rotation. I remember a couple of patients having bad complications from hemicolectomies for colon cancer and couldn’t help but think that if these patients had just undergone screening colonoscopies this could have been prevented. Quality improvement is another area of interest of mine and I was fortunate as a resident to participate in projects to improve inpatient bowel preparations prior to colonoscopy and improve the management of acute pancreatitis.

5. Outside of your daily practice, do you have any personal or professional projects that you’re passionate about? Please explain in detail.

I’m a huge sports fan number one. My favorite is football, especially the NFL (go Broncos!) but I also really like basketball and baseball. I’m also a big exerciser and really enjoy reading. I mainly read about current affairs and history, but will also read science books as well.

6. What is a common misconception that other clinicians have about gastroenterology?

That all we talk about all day is poop. Don’t get me wrong, we do a lot of talking about (and looking at) poop, but it’s not the only thing we discuss!

7. Who are your mentors?

Throughout my training, I’ve been blessed to have several wonderful mentors. Obviously, my father as a practicing gastroenterologist has always had a tremendous influence on me. As a resident, I became involved in several research projects with one of the advanced endoscopists at my residency hospital, Dr. Rajesh Keswani. He was an invaluable source of advice for me and taught me a lot about research methodology. Moving to a new hospital for fellowship, I’m currently in the process of establishing new mentors.

8. What’s the best advice you’ve ever received?

While it’s hard to choose only one piece, one comment that has always stood out to me was from the internal medicine program director from where I went to medical school. He told my class while we were preparing for our internal medicine shelf exam that the best subspecialists are good at what they do because they are great internists. I couldn’t agree more and try to remind myself of that every day now. I try to make sure to put a patient’s GI disease in the broader context.

9. What has been your most gratifying moment of being a clinician?

If I had to decide on one thing, a specific patient comes to mind. He was middle aged gentleman who came to the hospital with influenza pneumonia complicated by bacterial superinfection. I took care of him for almost two weeks in the ICU and got to know him well. Eventually he improved and was transferred to the floor. I visited him the day he left the hospital and the level of gratitude he expressed to myself and the rest of the ICU team was so profound and he couldn’t stop thanking us. It really stuck with me.

10. If you weren’t in this specialty, what specialty would you do? If you weren’t a clinician what would you do?

It’s hard for me to say any other specialty because I’ve truly always wanted to be a doctor and specifically a gastroenterologist. If I had to choose a profession outside of medicine though, I think I would have become a college science professor. I love science and love teaching and this is obviously a job that marries the two.

11. How do you motivate patients to do what’s best for their health?

In my opinion, this can be one of the most challenging parts of medicine. While I don’t have an absolute answer for this, what I have found works best is to simply be upfront with patients. When I have told a patient plainly that they need to change something or else their health is going to suffer, in general they make a genuine effort to change things.

12. What is the biggest challenge or obstacle in gastroenterology?

Like a lot of fields and going along with some of the other questions that have been asked, the pace of change is a huge challenge in GI. It is a field with such constant evolution that what you learned one year may not be true the next year so you really need to constantly update yourself on the latest literature. That’s a challenge but also a blessing as it really forces you to stay on the top your game.

13. What are your favorite Doximity features and how have they helped your productivity (Dialer, DocNews, Career Navigator, e-Fax)?

Doximity dialer is a great tool. It really increases the chance that a patient will answer the phone versus dialing with private caller.

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