Q&A with an Up-and-Coming Resident

Medical Education

When Adam Merando, MD, first began working at the Kansas City CARE Clinic in 2011, he was a newly minted resident who had recently graduated medical school at University of Kansas. He quickly learned the challenges of providing care to the uninsured and underserved at the clinic, one of the largest safety-net facilities in the area. Now a third-year resident at KU Medical Center, Merando can attest to the importance of incorporating community outreach into the Internal Medicine residency program. When Merando completes his residency in June 2014, he will become a chief resident; he credits his experiences caring for underserved patients in the community with providing the groundwork for his success.   

What made you decide to go to University of Kansas Medical Center for your resident training?

It was clear as a medical student that the atmosphere at KUMC was one of collegiality. We had amazing clinicians who were given the opportunity to form long relationships with their patients and their colleagues while also having the support to pursue academic and scholastic achievements. I quickly found that the department’s focus on resident education and support was superior to that of other programs that I was interested in. I feel that when I complete residency, I will be a competent and well-rounded internist. 

Why did you choose to specialize in Internal Medicine?

I have always been someone who questions things; who wants to know “why.” In Internal Medicine, we are constantly asking these questions. Why do people get sick? Why does this disease happen to this person? How can we improve the outcome for this treatment/disease? It was a perfect fit.  

There is also a constant struggle for internists to understand and realize the gravity of disease on a patient and the family, while recognizing the fascinating and extraordinary variations that occur in the human body in response to disease, infection and treatment. You have to be constantly aware of acute changes and willing to adapt and change when things don’t go as expected.   

What has your rotation at the Kansas City CARE Clinic been like?

It has been an amazing experience.  The work at KC CARE is extremely rewarding in the relationships that I have formed with their staff and with my patients, but sometimes frustrating in the difficulties getting patients the services and treatments they need. I have learned that the safety-net clinics and services in the Kansas City metro area are extensive and incredibly generous in their assistance to those with illness, yet lack the coverage and access to treat it. The vast majority of patients at KC CARE are uninsured, and many do not qualify for government programs for health care at this time. Family struggles, housing issues, and employment loss are significant stressors in the lives of my patients at the clinic, and it is incredibly rewarding if I can assist them with their medical needs and lighten the burden of their illness and disease on their lives. 

Can you tell us about your most memorable moment at the clinic?

I was working at the clinic one morning when the nursing staff nervously brought me the vital signs of my patient, and they were remarkably abnormal and consistent with those that we frequently see in the Emergency Room. I quickly went to his room and find an obviously ill-appearing young male with severe abdominal pain and distension. He had been feeling poorly all weekend but didn’t want to go to the emergency room because he was scared of the cost. We convinced him to go to the ER where he was subsequently admitted to the ICU and required ventilator support for a week. About a month later, he scheduled a follow-up appointment after his hospitalization and he asked to be in my clinic. Thankfully, he had normal vital signs and repeatedly thanked me for “saving his life.” Clearly, I had nothing to do with his hospitalization or intensive care stay, but he identified me as his doctor, and the possibility that I potentially played a role in getting him the care he needed was a gratifying experience. 

What did you like most about working in the clinic?

I love the patients who come to the clinic. Most of them are so grateful for the care that they receive. Many of them have had frustrations with the nuances of our medical system. Often, they have put off care and prevention because of other more pressing life matters until their disease is advanced. Many of these patients have long ago fallen from our guidelines and algorithms. It has made me hone my physical exam skills because I don’t have the luxury of ordering that extra imaging test to confirm my suspicion. It has required me to focus my differential diagnosis more and optimize the testing I have the access to perform. It has made me stop on multiple occasions and realize as Sir William Osler once wrote, “that it is much more important to know what sort of person has a disease than what sort of disease a person has.” So much of what we do at KC CARE is finding out about a person’s life and helping them to adapt with the struggles of life and illness, and to move forward with a healthier approach and with the assistance they need to control their illness and survive. 

How did your rotation help you in determining your future path?

I have always been interested in procedures and the ICU, neither of which is consistent with a career in ambulatory medicine. During medical school, clinic was not my favorite piece of medicine. I didn’t like the pace or the acuity. KC Care has renewed my appreciation of the clinic. I quickly realized that our job was to prevent “sick,” and I actually started to enjoy going to clinic. I was able to build a patient base that I looked forward to seeing, learning about their recent successes, talking them through their recent struggles, and finding out what happened at their kids’ and grandkids’ birthday parties and sporting events. I am still very interested in hospital-based medicine and intensive care, but KC CARE will always hold a special place in my heart for the experience it gave me as a resident, and I hope to always find time to have an experience like KC Care to remind me of why I became a physician in the first place.