How to handle GI emergencies

In this episode of the Small Talk, Big Topics podcast, host Dr. Matthew Whitson and guest co-host Dr. Kunjali Padhya are joined by Dr. Andy Tau to discuss GI emergencies in the hospital and how to prepare for them. Dr. Tau has spent six years as a GI hospitalist in Austin, Texas. He graduated from Harvard University and spent 11 years at Baylor College of Medicine in Houston where he completed his GI fellowship. He was named the 2021 Travis County Medical Society (TCMS) Young Physician of the Year and is a first generation Chinese American.

To begin, Dr. Tau introduces himself and shares his job responsibilities. As a GI hospitalist, he has never seen a patient in the clinic and works Monday through Friday. He notes his job comes with many pros and cons: when he is off work, he is off work, but one con is that he never knows how his patients do long term. If they don’t get readmitted, he assumes they’re okay. Another con is that he doesn’t see patients at their happiest moments, only at their worst state since they’re very ill. However, he shares that there is a very high return on therapeutic endoscopy and instead of working on a case for a long time, he can finish the work after stopping the bleeding. His mentors all had their own niches, and no one ever coached him into the in-patient world. He also doesn’t have any mentees in his job and says it can be very lonely. He shares cases and learns from a PA, but it isn’t community in the traditional sense.

Next, Dr. Tau shares how he’s come up with his own phrases of advice and shares them with the nurses since he doesn’t have fellows of his own. He discusses his approach when handling a GI emergency: he’s always thinking what to do next if things don’t go well and always has a Plan B, Plan C, etc. He also makes sure there are plenty of IVs and starts by shaking a patient’s hand to see if they are clammy, which could mean they have a bleeder. Dr. Tau also checks vitals again in a head down position. He prepares to do the absolute best he can, and always tries to keep the room calm by being jovial and light, but if things get serious, he gets serious.

Also, Dr. Tau discusses tools and techniques. He started bringing around different techniques that he has learned from the surgeons in his hospital. In his fellowship, the technicians did most everything with the equipment, but after his fellowship, he didn’t have their help, and had to learn all of these things on his own. He would also have to set up the scope or if things didn’t work, he had to open the manual to troubleshoot. His advice to fellows to inspire creativity and think outside of the box is to focus on the pain points that are encountered every day in order to find a solution. Dr. Tau shares how he keeps a journal of things that annoy him at his job to find creative solutions and to look to other specialties for ideas. His favorite or most impactful tool is the endoscopic vacuum therapy and his everyday favorite tool is the hot biopsy forceps. He advises trainees thinking about being a hospitalist is to seek out opportunities to use the devices as much as possible and suggests maximizing learning during fellowship since that may be the last time learning from others in that particular setting.