From the Hospital: An Insider’s Perspective

By Elaine Zhang, Graphics Editor & Ariel Kim, Managing Editor

Dr. Irene Zhang is a second-year general surgery resident at the University of Washington Medical Center in Seattle, WA. She graduated from Princeton University with a Bachelor’s degree in Molecular Biology and later obtained her MD from Harvard Medical School. In her senior year as a medical student, Zhang received the 2017 Hollis L. Albright, MD ’31 Scholar Award. She is excited to continue training in general surgery and plans to complete a fellowship, potentially in surgical oncology, or the study of tumors, after her residency. Dr. Zhang hopes to pursue the discipline in the future by operating, teaching, and researching.

Ariel Kim: What kinds of pressing issues regarding the US healthcare system do you see in your day-to-day experiences as a general surgery resident?

Irene Zhang: I would say that the U.S. healthcare system is very complex, high-tech, and expensive. Compared to other countries, you’ll see that here, for one patient, we are able to devote a lot of people, laboratory and imaging studies, and other resources to get them the right treatment. That is both a strength and a problem because on a national scale, that adds up to a very costly healthcare system. At the same time, we have the issue that not everyone has the same access to healthcare. We can observe that in the patients we see as well as in the patients we do not.

Elaine Zhang: What do you think is the importance of preventative care and disease screening?

IZ: Preventative care is definitely very important. In an ideal world, I think the role of preventative care would be something that everyone is able to get routinely, and the goal would be to reduce the number of difficult or late-stage problems that occur. In our system, it is done with some success. but could be improved. Screening for diseases such as cancer is something that I care a lot about. It gives us an opportunity to identify disease at a point when it is easier to treat, which often is what determines a patient’s outcome.

AK: What are some current technologies or policies employed that are part of the preventative care process?

IZ: As a whole country, there are a lot of guidelines for what kind of preventative care should be given, and I think that our hospital, along with a lot of other hospitals, tries to follow that. In terms of cancer screening, not every cancer has a screening test. There needs to be a reliable test as well as an agreed-upon path if the test were positive. Colon cancer screening, for example, can be based on the individual person, but it is recommended that the general population start from age 50 and get colonoscopies at least every ten years. And that’s something that our hospital tries to do; usually, the primary care doctors will guide each patient for when they are due for screenings. After their colonoscopy, patients will usually either be “cleared” until the next time, or they will have some results from tissue samples taken from the colonoscopy and sometimes a new diagnosis of cancer. Another example is women getting breast cancer screening, though depending on the result from the imaging, they may get additional imaging, take other tests, or be then referred to a breast cancer specialist. The whole idea of screening is just that it is a first pass to figure out if you’re “normal-risk” or “higher-risk,” if there’s something that needs to be addressed or watched. It works to systematically identify people without any obvious symptoms that we can help early on.

EZ: Is there a specific part of preventative care that you think needs the most improvement?

IZ: Going back to what we were talking about in the very beginning, we, as a country, as a system, have the knowledge, technology, and ability to administer these screenings or preventative measures. But the question is who is getting these screenings and who is not. For example, I work in Seattle, and there are multiple hospitals here. In the different hospitals, you can see the diversity of the patients who get care there. For example, at the university hospital, the patients are representative of a different demographic compared to the patients who go to the veteran’s hospital and the patients who are seen at the public/trauma hospital. At some of the hospitals, we are much more likely to see people who are not getting the right screening or prevention at the right time. It becomes a question of not being able to access medical care, which goes back to cost, insurance, and affordability. Some people also may not have the knowledge or medical literacy to know that they need to go see a doctor regularly either, and may not get seen until a problem reaches past that early stage. I think fixing this problem is about figuring out how to expand what we do to more people, more equally.

AK: What do you think about the doctor shortage and the length of training required to become a doctor? Do you think the 8+ years of medical training is necessary?

IZ: It is definitely true, especially in certain parts of our country such as rural areas, there is a big need for more doctors or medically trained personnel. But in terms of fixing that problem, I am not sure if the answer to that is reducing the amount of training involved. Medicine, the more I learn about it and how to do it, certainly does take time, experience, and knowledge in order to practice safely and effectively. Part of the reason it takes longer here, compared to other countries, is that we attend college then start medical training, so we have a lot of knowledge behind our backs in more generalized education. I believe that ultimately this is a successful system; the doctors that I have worked with and have seen practice are very skilled. While I do not have an alternative for the training, maybe the methods of other countries are also valid. One of the ways the U.S. is working on our ability to have more medical providers is by creating different roles in the system, such as physician assistants and nurse practitioners. People can find a niche where they can get shorter, more specialized training for such a role and do it effectively. I think that this is a great means to fill in the gaps in the system and to build the capacity to see more patients.

AK: What kinds of experiences did you have in high school, college, or even medical school that made you want to pursue medicine? Why did you choose general surgery?

IZ: I have always really liked science and working with people, and I believe that medicine is a good combination of those two. I also think that being a doctor is a unique way to spend your time and really make an impact on other people. That was something I was very much drawn to, both for medicine in general and surgery in particular. I decided to do surgery about ¾ of my way through medical school, while I was doing clinical rotations. What I really like about surgery is that usually we are dealing with problems that have solutions, and we get to be part of that solution. That is not the case for every patient we see, but often, we get to fix something and then see people get better, which is really amazing.

EZ: What do you think is important for a student thinking of pursuing medicine?

IZ: For students, I think that you have time to explore what you like and what you’re drawn to. Think about the classes you like, questions you think about often, and topics you like reading about. Medicine is a very challenging field, but it is something that I have personally found rewarding. If you are interested, try talking with patients or doctors, maybe do some volunteering, and see what medicine is really like. It is a little hard to describe to someone who doesn't spend their time in a hospital. Sometimes people have personal experiences, where they themselves or a loved one have spent time in a hospital, and that really affects how they perceive it. Throughout your studies, do not feel pressured to focus on sciences either. A lot of people in medicine have all kinds of different backgrounds. I was relatively traditional and studied science, and then also worked in business for a little while before medical school. But when I got to medical school, I met people who had studied art, history, computer science, and other majors but had then found their way back to this career in the end. There are a lot of ways to end up in it, and I would say feel free to explore what is interesting to you, especially in high school and college, when there are so many interesting things to learn about. I think that there is plenty of time to get to know medicine and consider it—it is a great path.