Health Careers With Dr. Marn
Health Careers With Dr. Marn
Pediatric Ophthalmology From The Practitioner’s Eyes With Tamiesha Frempong, MD, MPH
For a variety of reasons, kids can be born with or develop debilitating eye conditions from a very early age. These are the sorts of problems that the sub-specialization of pediatric ophthalmology deals with. In this episode, Dr. Richard Marn brings in Mount Sinai Hospital Opthalmologist, Tamiesha Frempong, MD, MPH to explain what pediatric ophthalmology means and what sort of conditions it deals with on a daily basis. Dr. Tamiesha also shares the variety of things that she does as an academic physician as well as the outreach programs and mission work that she is involved in. If you are considering a specialized career in ophthalmology, this episode is perfect for you as Dr. Tamiesha shares the qualities that can help you succeed in that career, as well as resources that will help you on your way.
To learn more about Dr. Frempong you may go to her Instagram account:
@miesha.frempong
Hello, and welcome to health careers with Dr. Mark, where we have deep, personalized and eye opening conversations with various people in health care. We learn what it's really like to work in different health careers from people who are living it today. I'm your host, Dr. Richard Marn. and welcome. Hello everyone. Welcome. Hope everyone is doing well. Before we get to our next guest, I just want to remind everyone to please visit the website for this podcast. You can do a number of things there. You can learn more about the show. Learn more about each guest to read. The show notes, even view the transcriptions for each podcast. And you can also sign up for my for my email list so I can let you know when the next show will be available. And finally, you can contact me Why would you want to contact me? Well, if you think there's a health career, you'd like to know about a guest that we should maybe invite to the show, you will find that a lot of our guests early on in the podcast will be people that I have worked with, or that I know, personally, and they are fantastic at their job. But I also want to have other people on this podcast, and invite other people to this podcast that are really good at their job as well that I just haven't known yet. So if you know someone, please that them or reach out to me or you reach out to me yourself and, and I'd love to hear from you. Of course, if you'd like to be featured on this podcast yourself, I would also love to hear from you. And then of course, there's people that maybe have a idea of how I can make this podcast better for you. For whatever reason, you can reach out to me through the website contact page. Again, the website is h c, with Dr. Marn calm that's H as in health, C as in careers, WI th Dr. Ma Rn comm Well, let's get on to our next guest here. So, the next guest is a good friend of mine, Dr. Tricia frimpong. Dr. frimpong is a Board Certified ophthalmologist and a pediatric ophthalmologist. She attended Yale University for college with a degree in psycho biology. She then became a Fulbright Scholar receiving a research grant. After that she attended Yale medical school. She also completed a one year Master's of Public Health degree at Yale. She then went on to a medicine internship at Mount Sinai School of Medicine, did her ophthalmology residency at the University of Pennsylvania School of Medicine and finalized her training at the Duke University School of Medicine in pediatric ophthalmology and strabismus fellowship. She has several awards. One I already mentioned was a Fulbright research grant, but she also is part of the AOA or Alpha Omega alpha Honor Society. She belongs to several appointments such as a member of the women in ophthalmology, the American Academy of ophthalmology, and the American Association of pediatric ophthalmology and strabismus. She is presented several lectures and presentations at various meetings in multiple countries. And she currently is assistant professor at the Department of ophthalmology at Mount Sinai in New York is the director of services of pediatric ophthalmology at Elmhurst Hospital in New York, and his vice chair of diversity and inclusion at Mount Sinai health system in New York City. I really enjoyed this interview with his good friend of mine, and I hope you enjoyed it too. Let's get started. Welcome to the podcast. Dr. frimpong How are you? I'm great. I'm so happy to be here. Yes, I'm very happy You're here with us today on for our listeners. Dr. frimpong. and I have known each other for a long time, I think 10 years. Yeah. When I was at Mount Sinai, we used to work together doing pediatric surgical cases. And we have a lot of fun.
Tamiesha Frempong :Yeah, we did. I miss you that.
Richard Marn :I know, I miss coming back there too. Um, but I would say, you know, at least my, my view my assessment, is that really, you're really a fantastic physician surgeon, super intelligent and very kind and caring and empathetic. I just wanted you to know that.
Tamiesha Frempong :Thank you, Dr. Meyer. And I'm so grateful. No, you know, I think that, you know, we're so fortunate to be healthcare workers, physicians, care providers, if you will, because we have every opportunity every day to show compassion and generosity and kindness. And those are some of the things that I love the most about the work we do.
Richard Marn :Yes, I mean, we have a very unique position only do you know as a career? I would describe yours as an ophthalmologist but you specialize in pediatric ophthalmology. Is that inappropriate description? And if so, what are your responsibilities?
Tamiesha Frempong :It is so, um, of course, we all train as general ophthalmologists first and then we can sub specialize. So my subspecialty is pediatric ophthalmology, and adult strabismus. So what that means is I do everything for kids, whether that means managing things as simple as glasses and amblyopia, which is a situation where they may not see well out of one eye for a variety of reasons, and may require patching or other types of intervention to help improve vision and the weaker eye. In addition to any other kind of pathology or disease that happens to the eye and kids so, believe it or not, kids can be born with cataracts or develop cataracts as they grow. They can be born with or develop glaucoma. They can be born with a droopy eyelid, which we call toeses, which can cause them to lose vision and various other pathologies of the eye. So I would manage those in for adults, I manage strictly double vision or ocular misalignment. So there are various conditions that can cause that some of them are systemic, some of them are isolated to the eye. And the management for that in adults could be medication versus special type of glasses called glasses with prisms in them, or actually surgery to correct the ocular misalignment and relieve their double vision if they haven't.
Richard Marn :What is You mentioned strabismus, what is that?
Tamiesha Frempong :So strabismus is misalignment of the eyes. So in order for us to have good by an ocular vision, meaning we're able to use the two eyes well together, we have good depth perception. We need the two eyes to be aligned and working well. When one eye is off center or not in alignment with the other eye, patients with good vision and he tried typically have double vision. And kids actually kids have a lot of adaptive mechanisms because their brains are so plastic and can adapt to various conditions. Adult brains are not as plastic or adjustable. And so an adult with a new onset, misalignment of the eyes, as long as they have good vision, not blind in one eye right or have severely decreased they will have double vision kids. You know, kids rarely complain about double vision maybe in the acute setting when it first first happens, if they're old enough to appreciate it, they may have double vision and then they would close an eye to eliminate the second image and that kind of thing. So strabismus is also called squint for that reason, because kids it early on in the development of their misalignment may close an eye or squint an eye in order to eliminate the double vision but their brains are so adaptable that their brains learn how to suppress the second image, which is why strabismus or ocular misalignment in kids can cause vision loss. It's kind of a use it or lose it. situation. So if you don't use the eye, you will lose the vision. When you're young. How
Richard Marn :do you us You obviously take care of take care of very young children almost newborns, don't you at times.
Tamiesha Frempong :Yeah, absolutely.
Richard Marn :But vision is also very personalized. In other words, you know, what I see is not what you're going to see you know, versus some That's a that's an injury on an arm. Everybody can see it. So how does a young child, how do you know a kid who can't even talk yet? verbalize, they have a problem? How do people even know to check for that?
Tamiesha Frempong :Oh, that's that's a good question. Um, so you're right vision is a subjective experience, right? Just because somebody can see doesn't tell you how well they can see. You can tell whether or not somebody can see I mean, we've all seen maybe blind people in our lives and they don't seem to fixate well, right, their eyes may be wandering. If you happen to have ever seen a truly blind person, especially somebody who has been blind from early on in life will develop something called nystagmus. Or they can develop nystagmus depending on the cause of their blindness. Now understand Miss is shaky eyes so their eyes don't sit still. It's like dancing eyes, it kind of just moves around a lot. So nystagmus very, very early on in life tells you that your child Or a child is not seeing well. Also, you know, children aren't born with 2020 vision, you know, they, their, their vision, probably at birth is about 2400 it's blurry, they're not seeing very well. But as the visual system develops, children division develops better and then they start picking up fixation, they start tracking, you know, they may, they may stare at, you know, whoever speeding them or faces are a good visual target for kids, they like faces. So they, you know, they would, you know, hold on to your face or if you hold a toy in front of them, they will follow it. So there are very crude ways of making an assessment of whether or not someone can see or not, let's say a child had problems in their vision in one eye say that when I was fine when I wasn't seeing Well, sometimes if that happens, I told you it's sort of a use it or lose it kind of phenomenon, but you know, it's kind of a chicken and egg thing. If the eye is not straight, they'll lose vision. But if the eye doesn't see, well, it won't be straight. So, yeah, so sometimes strabismus can be a result of poor vision. Okay? So in that situation when a child comes in and and often that may be a warning sign to the parents that there's something wrong with with an eye or something wrong with the vision, I may be totally normal to that I may be anatomically normal, but there's something in the visual pathway, that visual system that's not working well. So in that case, a child comes in even a baby a nonverbal baby. Parents concern there's a problem visions not good when I seems to be wandering all the time or are intermittently wandering, but they noticed that the eyes aren't always straight. In that situation. If you cover the wandering eye, just put a hand over the wandering eye or put an occluder over the wandering eye. The child will still be fine. And cooing and playing but if you put in a hand or an occluder over the good eye or the sound eyes, we call it, then the child's would become very, very fussy letting and pushing your hand away and letting you know basically, that they're not seeing well.
Richard Marn :Sir, that's very interesting. So you can actually do some things to exacerbate the situation and help you lead you down to maybe a diagnosis down the line.
Tamiesha Frempong :Yeah, I wouldn't say exacerbate but just to uncover it, you know so, so if a child is you know, most people have have to two eyes right were born. Some kids are born without an eye actually, believe it or not. But most of most people are born with two eyes and if one eye is working well but the other eye isn't. A child may not be aware of that right? So a child may just be fine and they will never complain. That's why children when they do to their pediatricians even as babies and they have their well baby checks, the pediatrician will make some sort of crude assessment there as well. And then they also do vision screening once the child is sort of old enough to cooperate with that type of test, where they actually attempt to, you know, check the child's vision one eye at a time, because with both eyes open the child may seem to see, well, no problem. But if you include one eye, and especially if you include the good eye, you'll uncover the problem and the problem by
Richard Marn :you know, as you work in academic center, Mount Sinai Hospital. What, what is your day like? Working in that type of location? What is your typical day like, as a pediatric ophthalmologist?
Tamiesha Frempong :Yeah, you know, I think when you work in an academic setting, the day can be very, very good, right because some days you may be in the office, seeing patients all day Some days you could be in surgery and I think that's true for any Doctor Who, whether you're in private practice or in an academic setting, what's different about being in an academic setting is that you also have academic type responsibilities. So for example, you may have to give lectures to students, whether that be medical students or residents or fellows, you may serve on various committees. When mountain I did have the Alpha Omega alpha society I was a member of that committee to it's an honor society in medicine to select medical students and residents or faculty members who've been nominated to join that society. So I was part of that. So that requires going through applications and then having meetings and, and making those straight decisions. I'm also part of something called the grievance committee at the Medical School. So, if an issue comes up, whether it be, you know, a sexual harassment or some way that a faculty member or student feels that they're they've been harmed in some way discrimination, various issues can come up. And so I would be part of a committee to hear those issues and make some judgments about them. And these are all responsibilities that I take very seriously. I feel honored to be a part of them. It's a lot of work and but it it also gives us an opportunity to have fairness and equity in in in the system. So so so my day could be, you know, being in the office, seeing patients being in the operating room doing surgery, giving lectures or having various meetings. With regards to the committee's that I'm a part of the other thing that I do too, is and i and i found it I started for our department at Mount Sinai is the East Harlem health outreach program for ophthalmology. So I, I do that with medical students that is a student run organization that provides free medical care to indigent people in the East Harlem community. So people who don't have insurance, who could not get care otherwise. So I would staff and ophthalmology clinic initially I was doing it alone, but now several of my colleagues have joined in and so we all share the responsibility and that's done on a weekend, usually a Saturday, once a month or so once or twice a month.
Richard Marn :So you as an academic physician, you're able to not only do your clinical work, but you actually part time spending some administrative activities, some lecturing, and even some outreach. And and of course, this is something that that you choose. It's not. It's not something that people are requiring you to do necessarily. Um,
Tamiesha Frempong :yeah. I mean, I think you you tried to, some of it is, it's an alignment with your personal interests and values, right. So, so as an ophthalmologist, one of the one of the nice things about ophthalmology is that it lends itself very well to mission work and international work and volunteering. So I also work for a foundation called the virtue Foundation, and also another foundation called the West African health. The West African Health Foundation. And, and so I for the past seven or eight years, I've been going to seven years because this would have been my eighth year I believe, but we had to cancel because of COVID. Yes. Where I've been going to Mongolia and So to Ghana to do free surgeries for patients in a rural part of Mongolia and in, in a village in Ghana, to teach local providers and to and to help them with the overflow of cases that they have, if they, especially in some of these rural areas, there may not be a pediatric ophthalmologist. In fact, we only go to places where the there's a need, right. So if we if there's a place that I mean, they're, you know, in the capital, for instance, in Ghana or even in Mongolia in Olam Baatar, they're, they're wonderful ophthalmologists. They're right. And they're in their pediatric ophthalmologist there. So there's no reason for me to be there. Right. So but, but in the rural areas, that's where there's a dearth of providers. And so that's where we spend our time. Anyway. I can't justify I couldn't justify going to these Sort of exotic type or, you know, interesting places, if, you know, charity begins at home first. So, because of that, I decided to reach out to the medical students who were part of this East Harlem outreach program to establish an ophthalmology arm of it, you know, so, because there are plenty of needy people right in our own backyards. So, so some of the things you may initiate, but some of the things you're invited to, to do some of these administrative tasks, because somebody thinks that you know, you may provide a unique perspective or it may you may be well suited to participate in something like this. So, so, I am already a member of the eo society or Alpha Omega alpha. And so for that reason, I was asked to join the committee at Mount Sinai to select future candidates and the grievance committee was something I was invited to do, but I'm really that's one committee. I've been At all of them I really enjoy but I particularly enjoy that because I've heard several cases now and I do think, you know, being a woman of color that I would bring a unique perspective to making certain decisions that can you know, affect somebody's career or future Yes. So so I'm I'm that one I was invited to join and and I'm honored to do so.
Richard Marn :When you're in the clinic, what what does your day start like is it usually you show up at eight o'clock and nine o'clock and then you see how many patients a day you see. You see them basically you they come in, sit in a chair and you have a lot tools. Can you describe some of the specifics, the specifics of what you the tools you use when you examine somebody?
Tamiesha Frempong :Sure. So it depends on the age of the person. Needless to say, what I would use on a baby is not the same thing I would use on a 17 year old or a 65 year old. But in any case, yeah, the day typically starts around eight o'clock. And fortunately we have technicians that also assist us right? So they would be the first point of contact after the patient is checked into the office. The technician would take the patient into a room and get a bit of a history know why the patient is there. No, you know, whatever other medical problems they've had, what are the surgeries they may have had, what medications they may be taking, and then they would do the basic exam. So the basic exam would would include checking vision, checking, if the patient is wearing glasses, checking to see what is in their glasses, and then checking a refraction so to see if what they need to see well jives with what they're wearing. And if they're not wearing something then they may need to be wearing something which may be the reason why they came in. So they'll check vision, they'll check the refraction, they'll check the eye pressure. And then and then I would come into the room. So I would come into the room, I would again, you know, introduce myself if I don't already know the patient, find out a little bit more details about why they're there, or if we're already managing condition that they have finding out, you know, how our interventions are working for them. And then I may sometimes have to repeat some parts of the exam. If I find some inconsistencies, you know, that I expected them to see better, or I don't expect them to see as well as what was recorded. Sometimes that can happen in amblyopia. You know, a child has decreased vision in one eye, maybe we're patching and giving them glasses and that sort of thing. And then they miraculously they come in and then their vision is miraculously better. And I'm like, Okay, I'm, I think I'm a good doctor, but I don't think I'm a magician, you know, and so I would recheck the vision and find that you You know, the technician didn't realize that the child was peeking. So the child was actually, you know, not fully occluding the good eye. And so that was, you know, the vision that was measured in the, in the weaker, I was actually coming from the good eye. And kids don't do that to be dishonest or, you know, they they're just trying to win, you know, they're trying to be right, they're trying to make you happy, you know, so, so that's always a little a little, you know, Pearl to consider when you're, when you're, if the numbers don't make sense, you know, recheck, just like if you check somebody's blood pressure, and it seems way higher than you then they are normal or way lower than their normal, you know, you have to reach out because it could be so so anyway and then, and then I would check the ocular alignment, if that's an issue for them, and then I may have to put in dilating drops. So we can also examine the back of
Richard Marn :But you're also do now this is part of the clinic but you also do surgery. Yes. How is that different than what you're doing in the clinic?
Tamiesha Frempong :Oh, the environment is just so different, you know, I love surgery actually and which is why I chose to, you know, chose the surgical subspecialty in the office, you know, you're you're seeing patients you're prescribing things or, or even discharging them from your practice if they're fine and don't really need anything, although people usually need at least an annual exam just to make sure everything is okay. You know, and that's an in and out, you know, patients are, you know, coming in and going out and coming in all day, it's that same thing and a typical day, you know, I may have anywhere from it depends 30 to 50 patients on the schedule for a given day. in the operating room, it's a it's a smaller number of patient Right I may have anywhere from, I don't know, on a on a busier day six or seven and on a lighter day, maybe three or four cases on and those are, you know, the cases may vary it may be a cataract case it may be a lot of what I do is a strabismus because that's more common. And it could spin you know, the age range, as I said before, but that is that environment is very different, you know, clinic environment versus the operating room. The operating room is, you know, very controlled. It's all a team based approach. But the thing I love so much about surgery is the dance we do you know, I think it's sort of this choreographed dance when everybody is doing their job and doing it well. It's beautiful, right? Like you. There's there are times when you're operating. You don't even really have to say much, you know, everybody is sort of in that zone is following along with surgery and knows what you need and is making adjustments to, you know, helping your exposure or what have you. And also, as you know, Dr. Marn, working closely with your anesthesiologist can make or break a case, you know, so I've been very lucky in working with you and Dr. Renee Davis and and, you know, other other pediatric anesthesiologist at Mount Sinai, that, you know, so contribute to, you know, an efficient and pleasant work environment.
Richard Marn :Do all ophthalmologists do surgery?
Tamiesha Frempong :No. Many do. Probably the majority do. But there are some ophthalmologists like for instance, some neuro ophthalmologist who don't do surgery at all. That's one specialty that may not do surgery. Also, but but I but there are near ophthalmologists who do still do some surgery or to do surgery. Medical retinas specialists don't do surgery in the operating room, but they would do inter ocular injections, you know, injecting medicine directly into the back of the eye or front of the eye. They would do laser procedures in the office and that sort of thing. So they do they're very procedure oriented, but they wouldn't be doing surgery as such in the operating room.
Richard Marn :Okay. Can you describe a Can you tell us a patient or that you took care of that really left an impression on you?
Tamiesha Frempong :There's so many. One that, uh, one that pops up to pops into my mind that touched my heart when I was a resident. It was when I was a resident. And, you know, we do a lot of cataract surgery in adults. In residency, people who are general ophthalmologist or cornea specialists or coma specialists may continue to do a lot of cataract surgery in their regular job. But for me, my adult cataract surgery experience was very concentrated in my residency. And I remember there was this woman and I can't remember exactly where she was from. I know she was Asian, and I know she didn't speak English. And she came in for her cataracts eval with her son. And her vision was horrible. She saw like counting fingers vision, like she could just, you know, put fingers up in front of her, she can see that but anything beyond that she couldn't see. She had very dense white cataracts. So I remember doing I think it was her first cataract, first eye and it was a very difficult case because our cataracts were so dense, and so we had to use quite a bit of energy in the eye. And so the next day We always see patients on what we call post operative day one. The day after surgery, she had a lot of corneal edema. So her cornea was swollen, and it was a little cloudy. So her vision was certainly better the day after surgery than it was before surgery, but it wasn't anywhere near perfect, right. And then a week after surgery, we saw her again. And she came in hugging like, hugging me like good doctor, good doctor. And then her son told me that like a week or so, you know, a few days ago or about five days after the surgery, she woke up one day and started ferociously cleaning her house because she said this place is adult vision was so bad. And so that was really a touching moment, you know, because you took this person from practical blindness to you know, Good vision
Richard Marn :to clarity.
Tamiesha Frempong :Yeah, so that was really something. That's awesome. I have another story.
Richard Marn :Yeah. Um,
Tamiesha Frempong :so this this also was in my residency but I, I, the lesson was reinforced in my fellowship. So a woman came in with what we call an eye, cicoria. She had a difference in pupil size. So when people was small when people was very big, and that's a neurologic emergency, right? Because it could be something going on in the brain and something going on in the brain that could kill you. So she comes into the emergency room and there's, you know, they do like a million dollar workup. And you know, she has an MRI and all this stuff to look to see if this woman is having some sort of pathology going on in her brain. And she comes and then they, you know, they they called off pathology and we came to evaluate the patient and we found out that her dog had a corneal ulcer, and she was a part of the treatment for the dog was using Atrazine. eyedrops, and so atropine is an eye drop that dilates the pupil. So she she had ended up having some of the drop on her finger not realizing robbed an eye and dilated her own people and atrophy and can last for a week. So, Oh, right. So the key there was getting the appropriate history. You know, and I remember when I was in my fellowship, I trained at Duke with a preeminent pediatric ophthalmologist is also a neuro ophthalmologist who's also now the chair of ophthalmology at Duke. His name is Ed Buckley, and you know, he's he's just a masterful in this specialty. And so patients would come to him from all over having gone to all the preeminent programs in the country for whatever Their issue was right. So they go to Baskin Palmer and Johns Hopkins and you know, all these great places, and then they come to him. And sometimes the solution or the the diagnosis was so simple. And he would say, you know what this patient needed a doctor who listened to them, you know, because sometimes it's just getting the right history. You know, sometimes we get so caught up in what we're seeing that we forget to ask the patient. Tell me what happened, you know, when did this start, and we're trained to do that. But sometimes I think that's why I think it's always so important to have a pattern to have a system of doing things so that you don't skip through steps, you know, and so have a systematic approach to every patient so that you know, you don't miss something.
Richard Marn :You know, often I think of ophthalmology as very technical as a very technical stuff. specialty. But you're you know, you highlight that it's, it is very technical, but you also have to still be very much of a physician and take a thorough history and not just focus just on the eyes.
Tamiesha Frempong :Well, I'll tell you something about that. I remember when I was in medical school trying to decide what to do. And I changed like initially when I came to medical school, I said, I don't know exactly I thought I wanted to be a pediatrician, general pediatrician, or maybe a, a pediatric hematologist because I had a huge interest in sickle cell disease and did some research in that before medical school and so that's where I was leaning. And I said absolutely not surgery, absolutely not surgery because some of the personalities of the people in my in my medical school class, who wanted to To be surgeons were the, you know, Uber type A is like super aggressive. And you know, I think I'm certainly type A and I'm certainly, but but I'm not. I don't know that we call them gunners in medical school. I don't know. Yeah, you know, that wasn't really my personality. So I said, Absolutely not. Not surgery until I actually what I had a, one of my first rotations in medical school was it was EMT, and the head of EMT at that time was a man called Clarence Misaki. Again, a masterful masterful surgeon who would do complex head and neck dissections. And he thought, I think for various reasons, I you know, I was very into it. I loved being in the operating room. I think I was a good assistant as a medical student, you know, learning you know, our job is to sort of suction and, and keep the smoke away. and dab the area of blood and retract the tissue to help with visualization. And I think I did that pretty well. I think that's I think I think he noticed that I was paying attention and that I was following along and then at the end that he would throw me a bone and teach me how to close skin and he told me I had good hands and he was really encouraging me to do it and today I regret not exploring that more The reason why I did it was because he was doing all this complex surgeries I was like, Oh my god, this is stressing me out. No, I can't I don't want to do that. Now. You know, in any case, once I once I explored once once I thought I could be a surgeon and I realized how much I actually loved it. I I learned more about ophthalmology and did a rotation and really enjoyed it. So yes, it's very technical, but when I was trying to decide on ophthalmology, I thought, oh my god, really I'm gonna learn all this medicine and then just be an eye doctor, you know, just just focus on this one organ. I don't know if I could do that that just seems like silly. It seemed silly to me at the time, until I understood that, as an ophthalmologist, you still have to be a doctor. You know, you still have to understand systemic diseases and systemic diseases with ocular manifestations because sometimes the first sign of your cancer, whether it be your breast cancer, or your liver cancer or your whatever can manifest in the eye, your first sign of diabetes, your first sign of an impending stroke, can happen in the eye. So you still have to be a whole doctor, and you still have to understand medicine and the human body. To be an eye doctor and to be a very good eye doctor to take very good care of the patients that interests, you know, their vision and their lives really to you.
Richard Marn :You know, I want to get to your origin story, because you alluded to it earlier. But before we move on, what is your favorite part about your job?
Tamiesha Frempong :I would say, my favorite part, I mean, I like I said, I love surgery. I it's funny. I was I was talking about it with one of the anesthesiologist the other day, and you know, people talk about that flow state or being in a zone. And, you know, for me when I'm operating, if if, like, what is you know, an hour or 45 minutes for me feels like five minutes, you know, and so it's it's, it's sort of that one of those times where, you know, my everything my all my efforts, my mind my focus is so concentrated, You know, so I really enjoy surgery. But I think equal to enjoying the surgery is enjoying the human relationships. You know, I think that as a, as an ophthalmologist, as a doctor in general, you meet so many people, so many people, so many backgrounds, who invite you into their space, literally, you know, you're very close to the person, they invite you into their lives, they share very intimate things with you, they trust you. And that's an experience that I think we're really I feel very privileged to have. And I think as doctors we're all very privileged to have. So I always think of it as you know, it's, it's the patient's choice to choose me or to come to me, but it's my privilege to be their doctor. So I really really enjoyed that. That part of it.
Richard Marn :Is there any part of you Your job, even the job description that is not very exciting, even mundane at times,
Tamiesha Frempong :of course for sure. Uh, I mean, gosh, I didn't even Of course, I mean, there's it's not like it's Oh my God every day, you know, rainbows and ice cream. Um, you know, sometimes patients can be frustrating. I'll tell you right now, during COVID I've been working at Elmhurst, and, you know, clearly I'm not a critical care doctor or pulmonologist or I don't have a specialty that is critical in in this COVID pandemic right now. But I do think as a healthcare worker, again, you know, I have a duty to help and a duty to serve. So what I have been doing most recently are video visits, right. So I've been going into the hospital and I've been covering the The vented patients, the patients on ventilators, particularly those patients because we did notice that some of them are having exposure Carrot Top puffy. That means that sometimes invented patients, they can't close their eyes because they're paralyzed and they're heavily sedated. And so with the eye being of it, which is why Dr. Martin and all of our cases that we do, or even cases that you do, that's not I cases, you guys always take the eyes shut, right or when, when we're operating on one eye, we always take the other eye shut, right to protect the eyes. And so some of the vented patients are always closing their eyes all the way and then is the eyes just constantly exposed to air, it gets dry, the conjunctiva gets swollen and can bulge out the cornea can develop, you know abrasions and scars. And so we noticed that when we were just helping out with these video visits Me and one of my colleagues. And so then we decided, you know what we should take charge of all of the vented patients with these video visits that way we could do bedside eye exams. And we created a flow sheet to help the nurses and doctors on those units on how to manage these conditions, how to how to evaluate who needs what, and then and then So anyway, I've been doing that and with the video visits, families are so grateful, right and and it's been an emotional and sometimes emotionally draining experience because you know, you're part of a very intimate moment with families that ordinarily as the doctor you wouldn't, you would not be in the room necessarily while the family is visiting. Right. That's a private moment. So you get to be a part of that moment and sometimes it's very emotional and people are crying and you know the horror and fear on a family members face when they see their family members. So sick and on the event has been, you know, it's brought me to tears during those visits. But then there's some family members. One that I can think of in particular, that it makes me sad when people can be so caught up in their own grief and their own, you know, challenging time that they don't also think about other people, you know, so there's one family that like demands multiple visits a day, and just it just, you know, it. It upsets me to an extent and I feel badly for being upset about it, you know, because I understand their grief and they're, you know, they're hard time. But you know, if if And the hospital has been actually very accommodating and, and in honoring their requests for three visits a day, but you know, that means that you know, another family, you know, if I, if I pray and I don't do it, I go once a day and then another teammate go later on in the day back to that particular family because, you know, there were now the problem has decompressed quite significantly, but in the beginning, when there were so many patients, you, you had to be a bit judicious with the time that you spent in each patient room so that every family can see their family member, you know, and so, sometimes that that kind of thing would bother me when patients and I know patients or people, right, just like doctors or people, and sometimes we're imperfect, you know, and sometimes we're selfish, and, and I'm sure I am too, you know, um, but sometimes when when, when people behave in a way like that. It does. make me upset and disappointed. And so those are understandable. Yeah, those are some of the things in the work and you can imagine, you know, sometimes if you're in an office and a patient's waiting a long time, and you know, I get their frustration too, but you know, it, that's what it's going to be sometimes, you know, let's say another patient is there who has an emergency and you have to spend a lot more time dealing with their acute issue. It's gonna, you know, delay the day for everyone else, you know. So sometimes you would hope that people can give you the grace that they would hope somebody else would extend to them or for that if they were the one in an emergent situation.
Richard Marn :Do you think there's any particular skills or qualities that make up a ideal ophthalmologist?
Tamiesha Frempong :Um, I don't know. If there's for for ophthalmology in general, I mean, I think having good surgical skills if you're going to be that type of Doctor Who does surgery, I think that's really important. You know, not every, not every doctor is a good doctor, not every surgeon is a good surgeon, you know, and I think it's important to know, your strengths and your weaknesses and be honest about that, you know, but I think what makes a good ophthalmologist is what makes a good doctor in general, you know, I think that's integrity, honesty, and being willing to, to be committed to your patients and be committed to their well being, you know, so you know, if you have if the patient has or if there's a bad outcome, you have to be willing to stick with it and see them through it and hopefully get to the other side of it. You know, it's not always success in everything, you know, and some of that is, you know, some of that is what the body is getting. To do and, and and and some of that may be what what what intervention you chose, maybe there's a better one or maybe there's a different one that might work better for this patient. And I think it's just important to be committed to the long haul, you know, some things are very, like, you know, the low hanging fruits, and a lot of what I do tends to be low hanging fruits, which is why I like what I do, because, um, you know, it's, it's, it's satisfying. It's like, it's like instant gratification, you know, that's, that's what
Richard Marn :I mean by low hanging fruit for ophthalmology.
Tamiesha Frempong :What I mean is like that woman who had like the Asian patient I told you about in my residence, right, she went from blind to a week later seeing free Shin Oh, God, like there's a there's a lot of things in medicine. That's a lot of sort of chronic disease. Personally, I really don't like chronic disease. I like problems that I can diagnose and fix and then you know, we're all happy and high five, but they're not always It's gonna be that way, you know? And so you have, you can't, you can't pick and choose and you can't say, Oh my god, no, this patient's going to be too difficult this case is going to be too difficult. Let me send it to somebody else. If it's out of your skill set, you know, then certainly do that. But if it's if it's just inconvenient, are gonna be too much work. You can't can't be that kind of adopter, you know. So, yeah, I think what makes a good doctor, what makes a good ophthalmologist is is that honesty, integrity and, and commitment to your patient's well being.
Richard Marn :You know, some you don't want to get to where you you, you talked about it briefly how you started thinking about becoming ophthalmologists. But even before that, were you always interested in medicine? Was that something that was on your mind when you were in high school? And college?
Tamiesha Frempong :Or even kindergarten? Maybe no. So, you know, I know a lot of doctors have this story. I do, and it's The truth but when I was like six years old, I said, I'm going to be a doctor because I want to take care of my grandmother when she's old. That was my really. Yeah, but I didn't know what that I didn't know what that really meant. I just knew I loved my grandmother so much, and I wanted to make sure she was always okay. Right when she got it. And so that's what I said, and then my family just wouldn't let it go. Okay, so me she's going to be a doctor. So then I really Oh, yeah. So, so it wasn't it and then I everything I did from that early on, or, you know, certainly, I mean, I was a very serious student, I really cared about my grades. I really cared about academics. I studied, like, you know, my parents are immigrants. And, and, to an extent that's almost been kind of a blessing to me, because, you know, they they didn't have a lot and they were just sort of focused on keeping shelter and food. You know, for us, we I didn't, you know, they didn't know, you know, extracurricular things for us and we were pretty much latchkey kids because they worked and we stayed home alone. You know, there were, there were three of us from my siblings. And then I had other cousins, and we all lived in this house that my grandmother owned, with multiple apartments in it. And so, we would all just go to school together in a pack and come home in a pack. And that's what we did. And I think that, you know, maybe because my parents were not so knowledgeable about, you know, enrichment things for kids or whatever, they were just trying to make ends meet for us that I had to find those things for myself, you know, so very early on, I felt responsible for my success, if you will, you know, and maybe that's just God. Grace and and blessing and not, you know, through my own efforts, you know, some somehow that thought came into my head that I needed to be responsible for my future at a very, very young age. And so I was a very studious student. And teachers recognize that and would, you know, tell my parents that I should do get into this extra talented and gifted thing and what have you. And then I went to, you know, a math and science sort of focused high school. I did research at Long Island Jewish hospital for three summers, when I was in high school and actually, out of that one of the researchers, Henry Eisenberg, who's now passed, he was a microbiologist allowed me to participate in a research project that they were doing so I had a publication in high school. And yeah, you know, so
Richard Marn :So you were proactive about your direction. Yeah. You saw those Research out the research didn't come to you. So let me go look into this.
Tamiesha Frempong :Yes however, there was a woman Her name is Carolyn snipe who also passed away several years ago from pancreatic cancer. And she was an administrator at Long Island Jewish hospital. Her daughter was a year ahead of me in high school and we were friends and because her daughter went to my high school, she her daughter was, at the time more interested in journalism. She wasn't pre med or anything like that. And she was a journalist for a while and is now doing other things. But Miss snipe started this research program at Li j targeted towards underrepresented minorities in my high school. So that's, you know, I'm not taking credit for just you know, calling them up and doing I'm saying this there was a parent who happened to be in A hospital administration who started this program, and there were several of us from my high school who today are doctors because of Carolyn snipe and because of this program and in this early exposure and support we got so we program Yeah, so but let me just say Mount Sinai has something similar to By the way, but let me just say this. So it wasn't until I was in college, that I was thinking, Wait a minute, I never considered anything else. Like what what do I want to be a doctor? Why now? You know? And so at that time, I started taking, you know, a history of art and psychology of religion and all these other types of courses, to just sort of broaden my scope. I didn't go to medical school right away, I got a research fellowship. But before I even did the research fellowship, I spent a few months working in healthcare consulting in Washington, DC. And that's when I was like, Ah, no, I don't want This office work, I think, I really think with medicine, yeah. It's just it's not the same. And and who knows, like maybe maybe I just didn't do it long enough or didn't find my niche or whatever. But the thing about medicine is that that made me realize that this was sort of better for me was that it's that that impact, you know, the impact on people's lives directly. That was very fulfilling, and is continues today to be very fulfilling to me. But my point is, I pigeon holed myself very early on, never really considered or explored other things. And I'm not saying that netstat is necessarily a good thing. I actually don't think it's a good thing. I think it worked okay for me because I was very focused and targeted. But you know, it's not necessarily the I would advise, you know, other people to approach medicine. If I had to do it all over again,
Richard Marn :what would you do differently?
Tamiesha Frempong :Okay, so yeah, I would have been a lot more open minded about other things, I would have read a lot more, just in general. Just Just read, read, read, read, read, read, whatever you can get your hands on read, be knowledgeable, you know, don't make decisions. In a in a vacuum. You know, I would have there were other types of programs out there. Like there's something called inroads. And there's something called SEO, I think it's a student education opportunity or something like that. That was also available in my high school and another people's high schools. So I recommend people look into those. And in those situations, those are more targeted towards business, you know, so students get placed in a company, and that's in college or high school, and then they get mentors and, you know, you learn different career paths in the sort of business sector, you know. Okay. So that's one one thing. You know, I think that as a child of immigrants also I was thinking about, I was thinking more along the lines of stability, you know, and medicine was, I mean, now look at COVID just wreaking havoc on, you know, the healthcare industry and, and ophthalmology in particular, you know, I think we're probably one of the hardest hit specialties in terms of, you know, our patient census, I mean, has gone to like, very, very low relative to how many patients we were seeing as a practice, you know, as a specialty in the country, but certainly in our department. In any case, it medicine was safe. In a lot of ways and and suited my sort of values and personality, but I think there are other things that could have to, you know, and I and I just I think that I would have, I don't regret being going into medicine, I actually think it's been a blessing. But I think I also, you know, wish that I had been a little bit more open minded about other things.
Richard Marn :You did mention about how the current pandemic has changed your career, at least currently. You know, and there's other things that are happening to you know, there's other changes that are, are big changes, you know, whether it's be changing technology, social media, climate change, and of course, the pandemic. Where do you see ophthalmology and pediatric ophthalmology? What changes do you expect to maybe five years from now? in your career? Yeah. You know, for yourself personally or in the grander scheme of things.
Tamiesha Frempong :Yeah, I think that technology is probably going to pick play an even bigger role in our specialty. You know, I think that this, this pandemic alone has pushed a lot of ophthalmologists and certainly an honor department towards telemedicine. You know, we've been talking about telemedicine and we've been, you know, years. Yeah, but now we're actually doing it, you know, because we have to, because there was no other way to actually see our patients and know what problems they're having and, and help them get whatever it is they need or even know that they're in an emergency situation and actually need to come in despite, you know, social distancing. And this pandemic, you know, there were our patients that we have had to see on an emergency patient basis, you know, that things that absolutely need acute care, and that's that's that's been happening, but I think that we We're going to have to find ways to use technology to make remote care. A real reality, you know, so I think we're gonna have to have more sort of artificial intelligence in our practice to help with screening and improving access to ophthalmologists, where you may not necessarily need to, you know, be in an office with somebody, but you can maybe have a device on your phone or, or some, you know, kiosk that you go into that does, you know, complete whatever and then sends that information to the doctor who can then you know, whatever, I just think that it's gonna be a lot more tech heavy and a lot more. You know, not as in office based practicing.
Richard Marn :Got it? Do you? Is there any way that or any resources that you could recommend someone to look into or people To be listened to or read about or organization to research online or or call to learn more about your specialty in your career.
Tamiesha Frempong :Mmm Hmm, that's interesting. You know, I think that they this generation or the this way we live today, information is now at our fingertips, right? Like you don't have to go to a library anymore and go look up books and check them out. You know, you can just go on the internet you know, there are there are just go on YouTube and then check out ophthalmology or, you know, their their surgeries that you can watch on YouTube or on the internet. There is the American Academy of ophthalmology website for pediatric ophthalmology. There's, it's the American Academy of pediatric ophthalmology and strabismus. You can look that up To learn more about pediatric ophthalmology, but honestly, I think that just googling the University of Iowa also has a lot of information and I think they had a website that was almost almost like a forum based I there's something else called student doctor dotnet that I was addicted to when I was in medical school. I don't know if you did that too, but no, that is student doctor dotnet is a forum of, of either people in residency or people applying for medical school or people applying for residency. And so you can get a lot of information about you know, different programs, information about the application process. You know, so if you were waiting like I remember when I was applying for residency waiting for interview letters, you know, people would post on there Like such and such programs sent out, you know, invitation letters yesterday. So if you got it in, you know, a few days, you know, you got an interview, if you didn't, you know, they did not invite you for an interview, you know, so and you can remember what a stressful time that was, you know, so it was nice having having those resources out there. So now I think if you want to learn anything about anything in medicine, just google it really, and really at Google videos or YouTube videos, it's almost like that rabbit hole, right? You'll use one link leads to another link leads to another link, but the information is there and I would, I would definitely encourage people to do their homework. You know, like I said, Don't make decisions in a vacuum. One other piece of advice I would tell people is I remember when I was in medical school, I had I gone to the same place for medical school and college. So my, my research mentor was my same we did this we did, you know, research together from the time I was in medical undergrad through out my college time. And so I went to him when I was trying to figure out what to do. And I and I said, Oh, you know, I'm thinking about dermatology, because dermatology still have procedures and, you know, maybe I would have been a mu surgeon or something like that or hair transplant surgeon. And he said to me, Misha, people who want to people who want to help people don't become dermatologists. That's just not true. That's not true. Right? Like, that's his opinion. That's that's not a fact. But you know, when you're so young, and you don't know anything, somebody who's been your mentor who knows so much more than you, you know, you accept that and you say, Okay, then I'm not going to do that. And I regret not running Remembering that or not knowing that at that time, advice is just a suggestion, you can take it or leave it, you know, and ask multiple people, you know, we know, nobody knows everything, you know, so constantly seek advice and guidance in everything even till today, you know, I'm, I'm a experienced physician and, and what have you, but I still will call up mentors or even, you know, my peers to ask their opinion about the management of this or how I should handle that and, you know, I'm always seeking advice. Even my college friends recently I called on them for advice on something really important. related to my work, and you know, and and none of them are doctors, you know, and they were very helpful in giving some advice and guidance. So I think always seeking guidance, you know, is very helpful. And it can come from various places. It doesn't have to come from another doctor or a super educated person or you know, and it can come from so many different sources.
Richard Marn :You know, Michelle, there's one thing that I wanted to talk about and I haven't brought it up yet. You were, and I only found this out after I got your resume and your CV. You're a Fulbright Scholar. Yes, thank you. I think that's so cool. Because that's only a handful people get to receive that honor every year. What, what, how did that work? Can you tell us what that is? And what you did with that scholarship?
Tamiesha Frempong :Sure. So, um, it's a research fellowship, and it's, you know, quite competitive and prestigious and you get support for In my case, it was recent. But other people do other types of projects. Mine was I told you I was interested in sickle cell disease. So mine was a project looking at the dysfunction of, of the spleen in patients with sickle cell disease and how that compares to a Ghanian population, so patients in Ghana versus in patients in the United States. And so I got support for that I had done a pilot study the year before. And then, you know, had had some evidence that this was worth studying. And so then created, you know, proposal and a grant application and was supported by Fulbright for that work.
Richard Marn :And you were doing research where during that time,
Tamiesha Frempong :I was in Ghana, in Kumasi. It's the second largest city in the country. At A hospital called accom prodigy it's it's a hospital, link to their their second largest medical school, the science and technology medical school in, in Ghana. And so that's that's where I had been based.
Richard Marn :I think that's pretty awesome.
Tamiesha Frempong :Thank you. So it was a very meaningful experience.
Richard Marn :Is there any other parting thoughts for a student interested in your career or even just lasting life advice?
Tamiesha Frempong :You know, I think
Richard Marn :you've given a lot by the way already.
Tamiesha Frempong :Oh, I'm good. I'm glad I'm glad. I think that I think it's really important to be honest with yourself, you know, like at some point, quiet the noise around you. Don't worry about what somebody else would think or What your parents will think or whatever, just, you know, when you're making decisions like this that's going to impact the rest of your life. Like I said, do seek advice, do seek guidance. You know, I'm not saying, ignore what they think I'm just saying, take a moment to pretend like you were just this island onto yourself and be honest with yourself about what, what, what's the thing that makes you jump out of bed in the morning, you know, what's the, what really makes you feel joy, what really makes you feel a sense of purpose or motivation. It may not be medicine, you know, it may be something very different. And, you know, be honest with yourself about what that thing is, and then try to figure out how to get closer to that thing. You may even be able to get closer to that thing indirectly through medicine or Part of medicine or what or what have you, but I just think it's really important to be honest with yourself about what you really want. I think a lot of times, and certainly for me, you know, I did a lot of what was expected of me or what was what was required to get to the next level without, you know, really examining, is this really what I want or this is really the best way to do this or, you know, that kind of thing. And, and, and, you know, I think, be bold in some ways to, you know, it may mean leaving your comfort zone leaving where you live, leaving your your neighborhood, leaving your country even. And I think it I say really ask those questions of yourself every a lot. Ask it over and over again, different different times in your life, that question may mean something different to you No,
Richard Marn :no. So, Misha, thank you so much for being part of this. I think this is a wonderful information you gave and perspective and i think i think a lot of people will will benefit from it,
Tamiesha Frempong :I think Yeah, thank you for asking me Dr. Myron. I'm so grateful.
Richard Marn :You've been listening to health careers with Dr. Month. If you like what you heard today, then please subscribe to this podcast. You can find this podcast on Apple podcast, Spotify, or wherever you get your podcasts. And if you know someone who's thinking about their career, please tell them about this podcast, health careers with Dr. Martin. If you're already a subscriber, thank you. And please go to Apple podcasts and read us or leave us a review. It's a great way to let other people know about the show. Or you can go to our website at Health Careers with Dr. Martin comm or hc with Dr. Marn calm through the website, you can subscribe to our email list. Contact me, let me know if there are any particular health careers that you'd like to hear about, and provide any comments on how this can be a better podcast for you. I'm Dr. Richard Marn. And thanks for listening and I hope you will tune in again