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Why Otolaryngology, Head & Neck Surgery?

Trying to figure out what kind of doctor you should become? Wondering what specialty you should choose? Then SheMD's Why Specialty Series is perfect for you! We're bringing you female physicians sharing WHY they chose their specialty. Today's post is on why Dr. Carrie Francis chose the field of otolaryngology, specifically pediatric otolaryngology, and why otolaryngology is a great field for all.

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“I don’t even know how to pronounce that” is often the greeting I receive from eager medical students after I introduce myself. I used to laugh and say “ENT”, but now I always respond slowly and with the phonetic spelling – oh·tow·leh·ruhn·gaa·luh·jee – as though the students can sense the diversity and amazingness of this surgical specialty with each syllable. I remember the first time I stumbled upon the specialty, and –quite literally – stumbled across its pronunciation. A mentor gave me a time and place to meet an Otolaryngology attending and resident for shadowing. I didn’t know what to expect as a first-year medical student because I had never heard of an otolaryngologist. I knew I wanted to be a surgeon at that point and figured I had nothing to lose. Little did I know that my future was unfolding before me. I still get excited when I’m asked to talk about my path to becoming a pediatric otolaryngologist and that of my specialty peers who are ear surgeons, nose surgeons, throat surgeons, airway surgeons, cancer surgeons, voice surgeons, sinus surgeons, sleep surgeons, plastic surgeons, and facial trauma surgeons.

I don’t remember much about my first ENT clinic or surgery shadowing experience, but I do remember how the experience made me feel. Confident. Capable. Not because I knew all (or even a quarter) of the answers to questions I was being asked; but because the team was there to help me tap into what I already knew to find the answers to questions I wasn’t prepared for. That was my first lesson as a future surgeon. Use what you have to problem-solve for the result you need. The second lesson? You aren’t in this alone. The ENT team held each other to the highest standards, and if I was going to be part of this team, then I would also be held to the highest standards as well. We rise or fall together. So, I knew without a doubt that I had what it took to succeed and that this group of people were on this journey with me. My path was set.

As a resident, I found that this experience really mirrored ENT as a specialty. We aren’t a body system, but a region. The anatomy and physiology of ENT pathology is tied to multiple body systems. Therefore, the success of our treatment plans and interventions is often tied to interdisciplinary collaboration. In my world as a pediatric otolaryngologist, I collaborate with lactation consultants, audiologists, feeding therapists and physicians in allergy/immunology, pulmonology and GI (just to name a few). And as the health of my pediatric patients is directly proportional to that of their primary caregivers, I also consider myself an advocate for my patient’s family. For example, one of my favorite patients (he’s since graduated from my care), came to me with chronic nasal congestion, ear infections, sleep disturbance, asthma and poor daytime quality of life. Mom smoked cigarettes in the home which contributed to his symptoms. I could have ignored it. It would have been easy to advise smoking cessation with variable results or response. Instead, I spent time building a relationship with her, sharing the impact of tobacco exposure, and listening to her story. She shared how she got started, what it meant to her now and the challenges to quitting. Over time, she quit smoking and while both she and I noticed an improvement in the health of her son, I was excited to learn about the successes of her own health journey. Win-Win! I treated her son medically and surgically but gained insight on the social structures that had just as significant an impact on his health and wellbeing. There isn’t one path to impact – I am able to change lives in ways big and small every day.

Whether in surgery or in the clinic, the best parts of me are able to come to life. I value harmony and have the ability to be a calm and comforting presence for my patients being wheeled into the operating room. I am curious about people and use that value to engage with them beyond their chief concern. On a recent clinic day, I saw a 7 week old with noisy breathing causing a failure to thrive, a 2 year old with recurrent ear infections and a speech delay, a 6 year old with a sleep disturbance and difficulty with concentration at school, a 9 year old with a large congenital neck mass, a 12 year old with allergic rhinitis and difficulty breathing through their nose, and a 16 year old patient following up after surgery to repair a nasal fracture. The medical variety seen each day in my practice is exciting. Add in the human factor and individual experience of health and no two diagnoses are the same! Some of these diagnoses are chronic conditions and I may see patients regularly for a year or more while others are short term – both very gratifying. As an ENT surgeon, I’ve literally watched some of my patients grow up (I have the annual school photos to prove it). Not many surgical specialties can say the same.

When it’s time to get into the operating room, a different element of patient care takes precedence. This is the time to activate executive functions. As surgeons, we are prepared for the procedure and any challenges that arise. A great perk of ENT is the tools we have at our disposal. Some technology allows us to watch surgical instruments in use on a screen like a video game. Others would allow us to retrieve a thumbtack from the windpipe. Even more exciting are implantable devices that can restore hearing. And though the surgical team is leading the operation, we are never working alone. Contrary to popular belief the operating room is another collaborative space where multiple members of the health care team (nurses, scrub technicians, anesthesiologists, and anesthetists) share responsibility for a successful case. Each discipline comes together to meaningfully care for the person in front of us. Some surgeries are long and others are short, but the environment is one where we work hard and enjoy lighthearted moments throughout the day. There is no better feeling than watching a 3 year old roll into the operating room in a big wheel with a huge smile.

And then there is the startling reality. Black women like myself and other traditionally excluded medical students are underrepresented in this surgical specialty. Along my journey there were times I struggled to find myself represented, connected or supported while being one of few in my immediate circle. This reality formed me, and, in many ways I look to deconstruct parts of the hidden curriculum that I learned during medical school and reassemble them in different ways. This change will support an environment and clinical practice that acknowledges historical harms and centers an equitable approach toward health justice and liberation. I am privileged to lead parts of this change through recruitment and mentorship of students, residents, and fellows along their journeys. I humbly support the next generation of learners and faculty advocates who work to dismantle and build new ways of thinking and being within our field. The long-term impact for patients will be beyond measure. I think of the many Black patients who, when I enter a room, release tension and state “I’m so glad it’s you.” I am one person using my platform and passion to dismantle rigid channels and expand the many pathways towards a career in medicine, and perhaps, ENT.

I may be the present, but the future of ENT is you. You’ve got nothing to lose and everything to gain in oh·tow·leh·ruhn·gaa·luh·jee.

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