In Touch Newsletter

D epartment

of

M edicine

Con ne c ti ng T e c h n o lo g y , Ed uca t i o n a n d D i s cove ry w ith H um anis m in Me dicine

Vol. 11 Issue 3 Jul. 2022

POCUS: Integrated Training for Internal Medicine Residents and Faculty As the race for medical technology and innovation carries forth, the education of young physicians must also develop in parallel to ensure proper utilization and understanding of how these technologies affect patient care. Over the last several years, the use of ultrasound has increased in frequency and many educators believe that it will become a part of the routine physical exam in the future. Dr. Mark Pierce of University of Tennessee Graduate School of Medicine (UTGSM) Internal Medicine and Dr. Francisco Soto in Pulmonary and Critical Care Medicine (UPCC) have both played pivotal roles in bringing this education to the resident and fellow level. Internal medicine residents currently participate in a team-based learning curriculum of bedside ultrasound techniques and starting with the incoming class of 2022, they will also participate in the Butterfly Academy. This opportunity represents a preselected group of core ultrasound courses created by the manufacturer of the popular Butterfly IQ ultrasound aimed at providing a strong framework for new users. In addition to increased access to ultrasound probes in the inpatient and outpatient settings, residents will now also have unique user profiles allowing them to save imaging for review and educational purposes. This is completed simply through connecting the probe to their iPhone and logging in through a downloadable application. The more accessible this tool remains to physicians, the more likely they are to incorporate this into their daily patient care as they would a stethoscope or reflex hammer.

Dr. Pierce states, “The sicker the patient the more likely ultrasound is to be helpful in your assessment.” There may be no better example

of this than the use of bedside ultrasound in progressive and intensive care units. Medical critical care relies increasingly on information obtained via ultrasound for both clinical decisions and the vast majority of modern bedside procedures. When discussing resident and fellow ultrasound education with Dr. Soto, he stressed the importance of muscle memory regarding the technique and that learner motivation beyond the base curriculum is key to long term success in its implementation. According to Dr. Soto, “A baseline curriculum is foundational, yet an opportunity remains for even further refinement of skill by implementing dedicated higher frequency practice sessions particularly in relation to the critical care setting. Much like playing a musical instrument or recognizing a subtle cardiac murmur on a physical exam, the utilization of ultrasound at the bedside is likely to also require practice and repetition.”

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Points of View

Beasley devoted his career to the Department of Medicine and successfully built the department over 31 years as Chair. The residency program flourished under his leadership, and despite many trials and tribulations he trained a whole generation of outstanding young physicians. He also hired many exceptional faculty members who continue as members of the faculty in the department to this day.

Dr. Beasley also had a pivotal role in the development of clinical medical ethics at UT Medical Center. Collaborating with Dr. John Eaddy from the Department of Family Medicine, as well as Dr. Glenn Graber, and Dr. Charlie Reynolds faculty at UT Knoxville; Dr. Beasley and colleagues developed developed a graduate concentration in medical ethics that had a clinical practicum -among the first of its kind in the country. Our own Dr. Annette Mendola, a graduate of this program, fondly recalls the guidance she received from Dr. Beasley and her integration as

IN MEMORIAM:

Dr. Alfred (Al) Beasley Dr. Al Beasley, the first Chairman of the Department of Medicine at University of Tennessee (UT) Graduate School of Medicine (GSM), passed away on March 8th this year. He was a much admired and respected physician and teacher.

Dr. Beasley graduated from the UT Rajiv Dhand, MD, Chair Health Science Center in 1959 and did his residency at the UT Hospital in Knoxville followed by a short stint in the US Navy as well as a cardiology fellowship at Emory University in Atlanta. In 1967, he was recruited as the first Chair of Medicine at UTGSM straight out of fellowship! He was the Program Director of the Residency Program and later Director of Graduate Medical Education at GSM. Dr.

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Hematology / Oncology Fellowship Program A group of individuals at UT Medical Center had a vision many years ago for the Graduate School of Medicine. They envisioned an institution with cardiology, pulmonary /critical care, and hematology/oncology and other core fellowships to enrich the established internal medicine residency program. This vision is coming to fruition as the hematology and oncology program begins its inaugural year on July 1st, 2022 headed by Dr. Timothy Panella as the Program Director. He has been instrumental in the growth of medical oncology in the hospital and the expansion of the Department of Medicine. He has been a practicing medical oncologist for many years and held the role of Chair of Medicine from November 1st, 2001 until June 30th, 2010. He hopes to incorporate his leadership and expertise into cultivating a successful fellowship program.

The implementation of this new fellowship program could not have come at a better time. The Bone Marrow Transplantation and Cellular Therapy Program recently began accepting patients for both autologous and allogenic transplantation. These services will provide an existential need to people living in East Tennessee. In addition to enhancing patient care, this fellowship aims to deepen the internal medicine residency experience. By having another core fellowship at the University of Tennessee Graduate School of Medicine (UTGSM), Dr. Panella believes this new fellowship will further attract top residency applicants from around the world.

Dr. Panella is excited about the two outstanding fellows who matched this cycle. One of the fellows, Dr. Heidi Worth, was a former resident who took a job as a hematology oncology hospitalist upon graduation. He had the pleasure of working with her in the clinical setting and with scholarly activity. Dr. Evan Davidson is an accomplished individual who exemplifies the values and mission here at UTGSM. Dr. Panella is confident these two fellows will make a lasting impression on the program.

There will undoubtedly be challenges that arise; however, Dr. Panella has minimized these by reaching out to other fellowship programs internally and externally to help design curriculums and frameworks for a new program. He is looking forward to collaborating with the new and old faculty within the department as well. UTGSM has a long history of excellence in teaching. Dr. Panella is excited to continue this tradition and hopes the hematology / oncology fellowship will promote future endeavors and continued growth of the institution.

Medical Student Education - The UT Graduate School of Medicine Clinical clerkship is a transformative phase of medical education.

Clerkship rotations are available for University of Tennessee Health Science Center (UTHSC) medical students at all 4 UTHSC campuses.

Brittany Bracco, GSM Administrative Assistant, says many students come to East Tennessee for their rotations if they are originally from this area, or to experience something new. There is also a strong word of mouth referral. “Our faculty are known as enthusiastic teachers,” she said.

Clerkship Director, Dr. Janet Purkey, says her goal for the Internal Medicine rotation in the core clerkship is to show students how an internist thinks. “I’m not interested in making everyone into internists,” she says. “Understanding what an internist contributes to patient care is important no matter what specialty you practice.”

Dr. Steven Rider, Director of the Neurology Clerkship, agrees. “In the third year, you’re going for exposure rather than expertise,” he says. The Department of Medicine offers a variety of fourth year rotations as well, including critical care, hematology, and cardiology. UTMC also offers the Capstone Course, a 4-week lecture series for 4th year medical students, every spring. Speakers include faculty, residents, and other content experts.

“Students especially appreciate topics related to the business side of medicine, as this is something they don’t get elsewhere,” says Brittany. “They also love having one-on-one time with the residents during the program.”

Dr. Rider loves teaching medical students. “I like being part of medical education. Teaching helps keep you current, and its rewarding to play that role in students’ lives.” Dr. Purkey agrees. “It’s awesome working with medical students. They are so motivated and eager to learn.”

POCUS: Integrated Training for Internal Medicine Residents and Faculty continued from page 1 Increasingly, the theme of ongoing self-learning in addition to a structured curriculum has emerged and Dr. Soto believes early recognition of residents and fellows holding particular interest in this procedure is paramount to creating a positive culture of learning towards the topic as a whole. In line with this, Preston Medical Library now carries a number of texts related to the implementation of ultrasound which are made available to residents, fellows, and attendings alike. The department would like to give special recognition to Dr. Pierce, Dr. Soto, Dr. Lamsen, and other colleagues who remain dedicated to this particular aspect of resident and fellow education.

Points of View

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a philosophy student into the clinical team. He emphasized that it was important to learn about the facts of a case but also understand what it was like for the people involved in these complex ethical dilemmas. In 1985, Dr. Graber, Dr. Beasley and Dr. Eaddy published Ethical Analysis of Clinical Medicine: A Guide to Self-Evaluation. This book was very favorably reviewed by the Annals of Internal Medicine and JAMA, both highly prestigious medical journals.

Dr. Beasley was a kind, supportive and warm individual who advocated for learners at all levels and was always ready with an illuminating story and hearty laugh. He was an ardent and loyal supporter of the department. He and his wife Sandy continued to attend the Annual Faculty Awards Dinner until recently. The Department of Medicine family owes a great deal of gratitude to Dr. Beasley for his many contributions and his benevolent presence will be greatly missed.

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Diversity, Equity, & Inclusion Spotlight: In this newly added column, we wish to shine a light on members of the Department of Medicine who come from a variety of backgrounds. The first person to spotlight is Dr. Isaac Biney, a Pulmonary and Critical Care attending who completed his fellowship here at UTGSM. Dr. Biney is originally from Ghana, a small country on the west coast of Africa, which he describes as “a beautiful, peaceful place with very nice people.” Dr. Biney is from the Akan tribe, the biggest tribe in Ghana, which makes up about 47.3% of the population. Although English is the official language he states, “there are hundreds of local languages, one of the most common dialects is twi.” He describes Ghana’s culture as “very diverse”, placing a strong emphasis on respecting your elders. He depicts a form of hierarchy within a family where you address older sibling(s) by their title, by placing either “sister” or “brother” before their given name. When asked about common foods, Dr. Biney states most dishes are rice or maize based, a popular dish he remembers fondly is fufu. Fufu is a cassava or plantain-based dish where the starch is boiled, pounded, and rounded into balls that are dipped into meat or fish-based soups. When speaking about traditions Dr. Biney states “there is a big difference between engagements in the US and Ghana.” When asking for someone’s hand in marriage, it is tradition that the groom’s parents visit the bride’s parents with local drinks and ask for her hand in marriage. At this point, the bride’s family composes a list and once the groom’s family fulfills this list, the marriage is official. Dr. Biney remembers Ghana very fondly and hopes to visit in the next year.

2022-2023 IM Resident Chiefs: Meet Drs. Chirag Patel, Marc Oropilla, & Zach Drew The Internal Medicine Residency Program would like to introduce the new chief residents for the 2022-2023 academic year: Chirag Patel, DO, Marc Oropilla, DO, and Zach Drew, MD. Dr. Patel will be serving as the inpatient medicine chief. During his time as chief resident, he would like to focus on academics to prepare current residents for their chosen career paths. He is also focusing on recruiting solid candidates for our program.

Dr. Oropilla will be serving as the ICU chief. He would like to work on improving conference attendance which will ultimately lead to higher ITE exam scores during his year as chief.

Dr. Drew will be serving as the clinic chief. He is passionate about improving bedside learning and is hopeful that rounds will return to pre-COVID times where medical school students will have the opportunity to be more involved.

Collectively, all three chief residents are continuing to focus on resident wellness. Most recently, our program was informed of a new lounge for the internal medicine residents located in the Graduate School of Medicine.

CME OPPORTUNITIES—MARK YOUR CALENDARS! Currently done hybrid with a limited live audience and others joining virtually via Zoom or Microsoft Teams

• Cardiology Conferences, held weekly on Wednesdays in the Medicine Conference Room for .75 hour CME credit.

• Medicine Grand Rounds, held on the 2nd and 4th Tuesdays of each month in the Medicine Conference Room for 1.00 hour CME credit.

• Ethics Case Rounds, held on the 4th Thursday of the month at noon in Wood Auditorium and are available for 1.00 hour CME credit.

• Pulm/HTN Conferences, held on the 2nd Monday of the month at noon in different locations and are available for 1.00 hour CME credit.

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Comings and Goings

Incoming NEW INTERNAL MEDICINE RESIDENTS

Kavi Dayaram, DO – DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Harrogate, TN Steve Ferlita, DO – Western University of Health Sciences College of Osteopathic Medicine, Pomona, CA Pavani Gingrich, MD – St. George’s University School of Medicine, Grenada, West Indies

NEW CARDIOVASCULAR DISEASE FELLOWS

Tyler Coombes, MD: American University of the Caribbean School of Medicine & Internal Medicine Residency at the University of Tennessee Graduate School of Medicine, Knoxville, TN

Nikhil Jain, MD: St. George’s University, School of Medicine, Grenada, West Indies & Internal Medicine Residency at the University of Tennessee Graduate School of Medicine, Knoxville, TN

Erin Hamric, DO – Edward Via College of Osteopathic Medicine - Carolinas Campus, Spartanburg, SC

Laylan Shali, MD: American University of the Caribbean School of Medicine & Internal Medicine Residency at the University of Tennessee Graduate School of Medicine, Knoxville, TN

Andrew Hartley, DO – University of Pikeville, College of Osteopathic Medicine, Pikeville, KY

NEW INTERVENTIONAL CARDIOLOGY FELLOW

Jonathan Hartranft, DO – Edward Via College of Osteopathic Medicine - Carolinas Campus, Spartanburg, SC Travis Moodie, MD – Sanford School of Medicine, University of South Dakota, Vermillion, SD Jared Odom, DO – DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Harrogate, TN Logan Shaver, DO – DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Harrogate, TN Alison Smith, MD – Ross University School of Medicine, Barbados Christy Smith, DO – Edward Via College of Osteopathic Medicine - Carolinas Campus, Spartanburg, SC Emma Zibas, MD – Quillen College of Medicine, East Tennessee State University, Johnson City, TN NEW TRANSITIONAL YEAR RESIDENTS

Collins Langley, MD – University of Health Science Center, College of Medicine, Memphis, TN. Plans to begin a Dermatology Residency beginning 07/2023.

Gabriella Santa Lucia, MD – Geisinger Commonwealth School of Medicine, Scranton, PA. Plans to begin a Dermatology Residency beginning 07/2023.

Coleman Churitch, MD – Quillen College of Medicine, East Tennessee State University, Johnson City, TN. Plans to begin a Radiology Residency beginning 07/2023.

Luke Maglich, MD – Morsani College of Medicine, University of South Florida, Tampa, FL. Plans to begin a Radiology Residency beginning 07/2023.

Chad Meadows, MD – Joan C. Edward’s School of Medicine, Marshall University, Huntington, WV. Plans to begin a Radiology Residency beginning 07/2023.

Madison Shadowens, MD – University of Arkansas, College of Medicine, Little Rock, AR. Plans to begin a Radiology Residency beginning 07/2023.

George Eigbire, MD: University of Debrecen College of Medicine, Internal Medicine Residency at Unity Hospital in Rochester, NY, and Cardiovascular Disease Fellowship at Louisiana State University Health Science Center in New Orleans, LA.

NEW PULMONARY/CRITICAL CARE FELLOWS

Samuel Treat, MD: St. George’s University School of Medicine & Internal Medicine Residency at the University of Tennessee Graduate School of Medicine, Knoxville, TN. Akesh Thomas, MBBS: Government Medical College in Kottayam, India & Internal Medicine Residency at Quillen College of Medicine, East Tennessee State University, Johnson City, TN. Syed Hussain, MBBS: Sheikh Zayed Medical College in Pakistan & Internal Medicine Residency at University of Pittsburg Medical Center, Pittsburg, PA. Served as Clinical Assistant Professor and staff hospitalist during residency.

NEW HEMATOLOGY/ONCOLOGY FELLOWS

James “Evan” Davidson, MD: University of South Alabama College of Medicine & Internal Medicine Residency at Augusta University, Medical College of Georgia, Augusta, GA. “Heidi” Anne Worth, MD: American University of Caribbean, St. Maarten & Internal Medicine Residency at the University of Tennessee Graduate School of Medicine, Knoxville, TN.

Graduating INTERNAL MEDICINE GRADUATES

Nick Cline, MD: Allergy Fellow at Cleveland Clinic, Cleveland, OH Tyler Coombes, MD: Cardiovascular Disease Fellow at UTGSM, Knoxville, TN Emily Daniels, DO: Primary Care Physician at Faculty Internal Medicine, Knoxville, TN

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Chad Hughett, DO: Primary Care Physician at Summit Medical Internal Medicine Associates, Knoxville, TN Thomas Lim, MD: Hospitalist TBD Sam Mowery, DO: Hospitalist for Team Health at Morristown Hamblen Health System, Morristown, TN Sam Purkey, DO: GI Fellow at Allegheny General Hospital, Pittsburgh, PA Megan Sears-Smith, DO: Hematology & Medical Oncology Fellow at Atrium Health Levine Cancer Institute, Charlotte, NC Laylan Shali, MD: Cardiovascular Disease Fellow at UTGSM, Knoxville, TN Jared Spoons, DO: Primary Care Physician at Summit Medical Internal Medicine Associates, Knoxville, TN Sam Treat, MD: Pulmonary & Critical Care Medicine Fellowship at UTGSM, Knoxville, TN Beth Wright, MD: Hospitalist at StatCare, Knoxville, TN TRANSITIONAL YEAR GRADUATES

Alexandria Atkins, MD: Radiology Residency at UTGSM Hayden Byrd, MD: Radiology Oncology Residency at Vanderbilt University Medical Center Rachel Dykes, DO: Dermatology Residency at Orange Park, FL Christian Gash, MD: Radiology Residency at UTGSM Michael Gerbo, MD: Radiology Residency at UTGSM Jake Saxon, MD: Radiology Residency at UTGSM CARDIOVASCULAR DISEASE FELLOWSHIP GRADUATES

Lon “Eddie” Abney, MD: Cardiologist at Presbyterian Santa Fe Medical Center in Santa Fe, NM Emmanuel Isang, MD: Cardiologist at University Cardiology, UTMC in Knoxville, TN INTERVENTIONAL CARDIOLOGY FELLOWSHIP GRADUATE

William Black, MD: Interventional Cardiologist at Alabama Cardiovascular Group in Birmingham, AL PULMONARY/CRITICAL CARE FELLOWSHIP GRADUATES

Megan Doyle-McClam, MD: Pulmonologist at AnMed in Anderson, SC

Ralph Maroun, MD: Pulmonologist at StatCare in Knoxville, TN

Faculty & Resident Awards and Honors Rawson Recipients

Clinic Star of the Year

The Rawson Award for excellent teaching and clinical skills was given to Dr. Emily Daniels, DO, and Dr. Ben Fogelson, DO, at the 2022 Department of Medicine Residents’ Awards Dinner. This award is given in memory for Freeman Rawson, MD, who joined the Department of Medicine in 1956 as one of our first teaching faculty and was known for his compassion and expertise. Dr. Rawson passed away in 2003.

The UT Internal Medicine Center presented the Clinic Star of the Year Award to Chad Hughett, DO at the 2022 Department of Medicine Residents’ Awards Dinner.

Congratulations to Dr. Hughett on his well-deserved award!

Medical Student Teaching Awards

The medical students who rotated through the Internal Medicine department voted to select the residents with the best teaching abilities: Drs. Sam Mowery, Sam Purkey, Sam Treat, Chad Hughett, & Tyler Coombes. Special thank you to Dr. Tyler Coombes as well for his role as the Medical Student Liasion. These residents were acknowledged at the 2022 Department of Medicine Residents’ Awards Dinner.

Jim Neutens Award for Best Teaching Division of the Year In 2018, the Department of Medicine created the Jim Neutens Award for Best Teaching Division of the Year in honor of Dr. Jim Neutens, who retired in 2018 after many years of service as the Dean of the Graduate School of Medicine. Graduating internal medicine residents select the department that made the most impact upon them during three years of residency training. For the fifth year in a row, this honor went to the Division of Pulmonary and Critical Care Medicine.

8th Annual Department of Medicine Research Awards On June 14th, 2022, the Department of Medicine held the 8th Annual Residents’ and Fellows’ Research Contest. A faculty committee reviewed the research papers submitted by Department of Medicine residents and fellows then selected the top three to present at the Research Awards. The audience voted to select the placement of the winners. Dr. Elliot Goodwin won first place with “A Perioperative Algorithm for Cardiac Rhythm Management Devices for Undergoing Magnetic Resonance Imaging: The PACEDMRI Protocol,” Dr. James Livesay won second place with “Heme Effects in Lowering Patient Discomfort in Radial Artery Verapamil Injection (HELP-RA),” and Dr. Ben Fogelson won third place with “Rural vs.

Urban Outcomes Following Transcatheter Aortic Valve Implantation”.

Good Catch Award: March 2022 Congratulations to Dr. Salem Karadsheh (PGY-1 in Internal Medicine) one of the recipients of the Good Catch awards for March 2022. Dr. Karadsheh discovered a medication order error. Monthly winners receive a Good Catch lapel pin, certificate, and a $25 Amazon Gift Card.

The Good Catch program encourages the identification of potential system errors or problems before they reach the patient and cause harm. The program recognizes team members for identifying and reporting these issues, leading to safer practices.

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Faculty Announcements: New Faculty We are elated to welcome Dr. Brent Coyle for the appointment to the rank of Clinical Assistant Professor. Dr. Coyle is a board-certified psychiatrist with the American Board of Psychiatry and Neurology.

He received his medical degree from the University of Minnesota Medical School in Minneapolis, Minnesota. He completed his psychiatric internship and residency at Wilford Hall USAF Medical Center at Lackland Air Force Base in San Antonio, Texas.

We are thrilled to welcome Dr. Saikrishna Gadde for appointment to the rank of Clinical Assistant Professor in the Department of Medicine. Dr. Gadde completed medical school at Louisiana State University Health Sciences Center in Shreveport, LA. He completed a residency in internal medicine at Brookwood Baptist Medical Center in Birmingham, AL; followed by a fellowship in hematology and medical oncology at Ochsner Medical Center in New Orleans, LA.

Faculty Promotions It can be challenging enough to juggle a work-life balance in the corporate sector, but being a physician adds another layer of stress and accountability. Since the University of Tennessee Medical Center is a teaching hospital, each of our faculty members are expected to contribute to teaching the next generation of doctors, submit publications to current medical journals, and participate in research projects all while continuing to treat and care for patients in the hospital and specialty clinics. Each of the faculty members below have consistently exceeded these expectations and continue to give their heart and soul to the medical profession.

Mahmoud Shorman, MD, MHA - Professor Amit Vora, MD – Clinical Associate Professor Joseph Peeden, MD – Associate Professor

New Staff This year we welcomed Leigh Anne Mynatt to the Department of Medicine as Hematology/Oncology Fellowship Coordinator. Leigh Anne will be working with Dr. Timothy Panella to support fellows in hematology and medical oncology. Leigh Anne has worked at UTMCK for 16 years with previous experience working with Dr. Wahid Hanna in the Cancer Center. Leigh Anne has a dedicated purpose to return to the division; she has a passion for the purpose to help physicians and their patients. Her father, Frank Carver, was a cancer patient and has a brick in the healing garden here dedicated in his memory.

She believes in the program and the research initiatives that will improve the prognosis and quality of life for cancer patients.

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Ethics Case Rounds: “I Don’t Want Surgery!” When a Patient with Equivocal Capacity Refuses Lifesaving Interventions Ethics Case Rounds are monthly, hospital-wide discussions of morally distressing cases. Cases are de-identified to protect patient confidentiality.

“Paula” is a 66 y/o lady who was admitted with toxic megacolon. Her history includes hypertension and intellectual disability. She lived with her sister until her sister’s death 5 years ago and has been a long-term nursing home resident since then. She does not have any other known living family members.

Surgery has recommended colectomy with an ostomy. Less invasive measures have been exhausted. She is expected to have a good outcome with surgery, but not expected to survive without it. Unfortunately, she consistently refused surgery.

Paula is pleasant but does not say much. She denied having any pain. She was able to recognize that doctors think she needs “a surgery,” but could not explain why or how it was expected to help her. With prompting she said her doctors think she could die without surgery. When asked whether dying or surgery would be worse, she said dying would be worse. However, when asked if she would be willing to undergo surgery to avoid dying, she repeated she did not want surgery. She could not explain why. Her capacity for this decision was considered to be equivocal at best. As she did not have anyone to serve as surrogate, the attending physician served as decision maker with support from Ethics as well as input from Paula and staff from her nursing home.

Equivocal Decision-Making Capacity Decision-making capacity is on a sliding scale: a person can be more or less capacitated, depending on a number of factors. Patients’ capacity is equivocal when they do not definitively demonstrate capacity or the lack of capacity.

When navigating decisions with patients whose decision-making capacity is equivocal, ask • Would the proposed intervention enhance the patient’s decision-making capacity?

• What is the magnitude and likelihood of the threat to the patient’s autonomy and well-being posed by each possibility?

• Are the effects of the proposed intervention temporary or reversible?

While surgery would be in her best interests and would seem to be consistent with her desire to stay alive, there were concerns that it would be extremely traumatizing for her to undergo such a life-changing procedure without agreeing to it.

Staff at her nursing home felt she enjoyed her baseline quality of life and thought she would adjust to having an ostomy, which they could easily manage. One of the nurses from her facility came in to visit her. She reluctantly reported that Paula never wavered from saying she did not want surgery, and that she’d said, “yes” when she asked if she would rather die than have surgery.

After much discussion, a joint decision was made for discharge back to her facility with hospice.

A week later, she was readmitted with a similar clinical picture, requesting surgery. However, she could not say why she changed her mind or explain the expected benefits or sequelae of the surgery (e.g., that she will have an ostomy bag).

All were in agreement that proceeding with surgery was in her best interests, even considering her earlier refusals and still-equivocal capacity. We again used the attending physician as decision maker with the support of Ethics, this time to provide consent. The surgery was successful. Paula was able to return to her facility and was doing well when she was seen in follow-up.

Comments on this case may be sent to amendola@utmck.edu References • Graber A, April C, April MD. Proxy Consent by a Physician When a Patient’s Capacity Is Equivocal: Respecting a Patient’s Autonomy by Overriding the Patient’s Ostensible Treatment Preferences. J Clin Ethics. 2018;29(4):266-275.

• Guidry-Grimes L. In the Balance: Weighing Preferences of Decisionally Incapacitated Patients. Hastings Cent Rep. 2018;48(3):41-42. doi:10.1002/hast.855

Presentations, Publications, Awards

Department of Medicine faculty, residents, and fellows share their knowledge and experience by publishing and presenting across the world. For a list of our most recent accomplishments, visit http://gsm.utmck.edu/internalmed/scholars.cfm.

Thank You For Your Support

For information about philanthropic giving to the UT Graduate School of Medicine, Department of Medicine, please contact the Development Office at 865-305-6611 or development@utmck.edu.

If you would like more information about any of the topics in this issue of In Touch, please contact the Department of Medicine at 865-305-9340 or visit http://gsm.utmck.edu/internalmed/main.cfm.

We look forward to your input. Thank you.

Stay In Touch!

Alumni, please update your contact information by completing the simple form at http://gsm.utmck.edu/internalmed/alumni.cfm or by calling the Department of Medicine at 865-305-9340. Thank you!

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In Touch Vol. 11 Issue 3: July 2022

Publisher Rajiv Dhand, MD, Chair, Department of Medicine and Associate Dean of Clinical Affairs Editor Annette Mendola, PhD Administrative Director Jenny Roark Contributors Jenny Roark Robin Underwood Rajiv Dhand, MD Annette Mendola, PhD Cassandra Mosley James Drew, MD Marc Oropilla, DO Shawna Stephens, DO Ashley Gutierrez-Santana, MD Design J Squared Graphics In Touch is produced by the University of Tennessee Graduate School of Medicine, Department of Medicine.

The mission of the newsletter is to build pride in the Department of Medicine by communicating the accessible, collaborative and human aspects of the department while highlighting pertinent achievements and activities.

Contact Us In Touch University of Tennessee Graduate School of Medicine Department of Medicine 1924 Alcoa Highway, U-114 Knoxville, TN 37920 Telephone: 865-305-9340 E-mail: InTouchNewsletter@utmck.edu Web: http://gsm.utmck.edu/ internalmed/main.cfm The University of Tennessee is an EEO/AA/Title VI/ Title IX/Section 504/ADA/ ADEA institution in the provision of its education and employment programs and services.

Disclaimer: quotes/ interviews are edited for length and clarity