The subject of 2015's first faculty spotlight got into medicine following in the footsteps of not only his father, but two of his sisters. Jonathan Bae, MD, talks to us about being part of a medical family, reviewing preventable deaths within the Duke health system, and how a residency training in both pediatrics and internal medicine influences his current work.
How long have you been at Duke? How long have you been at the division?
I’ve been at Duke for 14 of the last 18 years, and for almost the past ten years consecutively. I’ve had a love affair with this place since 1988 when my oldest sister, who is 10 years my senior, went to Duke for her undergraduate degree. Back then, it was more about the basketball but as it came time to apply to college, I also fell in love with the people, campus, academics, and opportunities being at Duke could offer. I was fortunate enough to attend Duke as an undergraduate and when I left for medical training at the VCU Medical College of Virginia, I always wanted to return.
I returned to Duke as part of the Medicine-Pediatrics residency program in 2005. I joined the division formally in 2009 when I finished the residency program and became a hospitalist at DUH. After working for a year, I served as one of the Chief Residents for the Medicine Residency Program. During that time, I began to build an interest in patient safety and quality improvement in addition to clinical education and administration. Upon completion of my chief year, I returned to hospital medicine and took on roles as the Associate Medical Director for Quality for Hospital Medicine as well as an Associate Program Directorship for the Medicine Residency Program, also overseeing quality and safety.
In both roles, I’ve had the opportunity to get involved in work around patient satisfaction, care transitions, and QI curriculum development among others. Just this past July, I stepped away from the APD role and took on a medical directorship at the health system to oversee inpatient mortality review.
What are your responsibilities within the division? What does a typical day for you look like?
My clinical time is spent as hospitalist at Duke Hospital where I split my time rounding with residents on the general medicine teaching services as well as rounding independently. I also spend some time teaching, mainly concepts in quality improvement, in addition to my time rounding. My administrative time is much more variable. I may go from working with a project team developing a standard discharge process for hospital medicine to mentoring residents and med students on QI projects on topics like resident burnout and patient satisfaction among others. A majority of my administrative time is spent working to implement a mortality review process for the health system. As part of this, I have had the opportunity to spend some time at Duke Regional and Duke Raleigh to help them implement their own mortality review process. I love this variety as it keeps things exciting and interesting and has connected me with various people throughout the health system.
You’re the Medical Director for Mortality Review within the Duke Health System. What does this work involve?
I am part of a team that is implementing a process for reviewing, in real-time, every inpatient death across the health system. Literature suggests that preventable deaths continue to be a significant contributor to inpatient mortality. Beyond the obvious patient safety implications, hospitals have become more interested in understanding mortality as it has become increasingly tied to reimbursement. With that in mind, it is not clear how many deaths at DUHS are actually preventable.
Thus, the goal of this work is to begin to quantify and understand preventable mortality at Duke and particularly the contributing factors such as medical complications, communication issues, and timeliness of care delivery. I started in this work on a much smaller scale in hospital medicine. Since then, the work has expanded from reviewing every patient that died on general medicine to reviewing all deaths across Duke hospital and Duke health system. Looking at all these deaths is a huge undertaking, but there is a real opportunity to identify key issues contributing to mortality, and truly, patient care in general, and that by doing so, we can keep our patients safer and deliver care more effectively.
What have you learned so far from this work?
One takeaway is that there are very different processes for reviewing deaths throughout the health system. There is lots of great work that is already being done, but there hasn’t been a consistent strategy, or even a common language, for review that allows us to compare contributing factors let alone learn from each other. So we are hoping that our process will provide structure and standardization that will tie these various streams together so we can learn from each other and identify opportunities to improve locally and across the health system.
How did having an older sister who practiced medicine influence your career?
It’s not just me -- I’m one of five siblings, three of whom ultimately became physicians. My father was a solo practicing pediatrician. My oldest sister Vickie is an Obstetrician-Gynecologist at UNC. My second eldest sister (Leslie) is in California, where she is an internal medicine physician in private practice. My brother-in-law is also a pulmonary critical care doctor. When you have a doctor as a parent, you end up either really wanting to be a doctor or wanting to do something completely different. My brother and little sister took that second path. My brother works for Duke Energy in Charlotte, and my little sister is a hotel manager in Virginia.
You spent your residency in Duke’s internal medicine pediatrics program. What made you decide to join this program? How did this time inform your current practice?
When I went to medical school, I had no idea of what I wanted to do with training. Every rotation ended up being something that I could envision myself ultimately doing. In the end, it became clear that what I really wanted to get out of being a doctor was to be able to take care of any patient that could walk through my door. As it came time to select a residency program, I was drawn to both medicine and pediatrics for this reason and had applications started to apply for both.
At that point, I learned that there was such a thing as a “Med-Peds” residency and the decision was made, which made the application cycle much easier to be sure. Even though my career has become much more focused on medicine, I consider my pediatric training invaluable. My Med-Peds training at Duke gave me a deep appreciation of the scope of illness across a person’s lifetime. Even though I’m only practicing medicine at this point, I use a lot of the skills from both areas and feel that I am a more well-rounded and complete physician as a result. I would do it again without question. What passions or hobbies do you have outside of the division?
I have two very active children, James and Owen, who are 5 and 6. They are best friends and mortal enemies, so the house can be quite raucous at times. They, along with an 11-month-old puppy at home keep me quite busy when not a work. My wife (Michelle) and I like to travel and we spend a lot of time at the beach or even just exploring North Carolina. When I have time, one of the things I love to explore is music. In fact, one of the reasons I was drawn back to Durham was the music scene here. Living in the Triangle gives me many opportunities to indulge myself seeing acts, large and small, in small grungy venues to larger places like DPAC or Walnut Creek. The quality and variety of the music scene can’t be beat which is one reason I’m probably an iTunes preferred customer. I’m also a huge Jimmy Buffett fan -- I think I’ve seen 26 of his shows so far – and I am fan of my hometown teams the Baltimore Orioles and Ravens. However, I would be remiss not to mention that I am, of course, a huge Duke basketball fan.
Jonathan Bae, MD, with his wife Michelle and sons James and Owen.