Medical Grand Rounds featuring Dr. Michelle Lamarche
Matthew James, MSc Candidate, Translational Medicine
At the March 28th Medical Grand Rounds, the Translational Medicine graduate students had the opportunity to hear presentations from two of the Internal Medicine Chief Residents. One of the presenters was Dr. Michelle Lamarche a third-year core Internal Medicine Resident at Queen’s, who presented on the topic of BNP measurement in patients with heart failure. BNP measurement has only recently become available at Kingston Health Science’s Centre, and Dr. Lamarche informed us that many of her colleagues were unclear of the best uses for BNP measurement in the diagnosis of heart failure. Since the physicians at KHSC have advocated to have BNP measurement available, Dr. Lamarche used her Medical Grand Rounds lecture to educate us on the proper indications for this diagnostic test.
The Canadian Cardiovascular Society (CCS) 2017 guidelines state that the best evidence for BNP measurement is to rule out a diagnosis of heart failure, or to recognized patients who are at greater risk for hospital readmission. Dr. Lamarche highlighted several key studies that confirm these are the best uses of BNP measurement. Dr. Lamarche also highlighted several uses for BNP measurement that have poor evidence. The CCS 2017 guidelines state that BNP measurement may be used to predict treatment response. However, when we examine the supporting studies more closely, we can see that the evidence for BNP guided treatment is poor, and thus Dr. Lamarche does not use BNP for that purpose in her practice.
We were also able to talk about the path that lead Dr. Lamarche to Queen’s, and her decision to pursue a General Internal Medicine Fellowship at the University of Alberta. Dr. Lamarche finds the multidisciplinary nature of the Internal Medicine service interesting and fulfilling. During our post rounds discussion, an interesting conversation regarding the place for research in medical school and residency programs developed. Dr. Lamarche believes that medical education should provide the opportunity for students and trainees to develop the skills they need to pursue different paths in medicine, whether that be through research, community involvement, quality improvement or medical education, but that ultimately Physicians must be encouraged to pursue the areas of professional engagement that they find the most fulfilling. Dr. Lamarche hopes to participate in quality improvement initiatives during her fellowship, which she has found to be professionally fulfilling.
A particularly interesting topic of our discussion was the future of medical diagnosis and the role of the physician in a rapidly advancing society. With the advancing field of Artificial Intelligence, complex algorithms designed for patient diagnosis are becoming increasingly accurate. While these technologies are still in early phases and far too costly for the Canadian health care system, we may find ourselves in a world in the not too distant future where AI is a part of the medical profession. While Dr. Lamarche had not spent a lot of time thinking about this, she did recognize that as a physician, adapting to advancements is part of the job, and although AI may become part of treating patients, this human interaction in medicine is often just as if not important than the treatment itself, and that is something AI cannot replace.
It was a pleasure having Dr. Lamarche at our TMED 801 Medical Grant Rounds discussion. We learned a great deal from her as a current trainee and wish her the best of luck at the University of Alberta.