Residency Spotlight

An Interview with Deb Houry, M.D., M.P.H.

Tell us about your career path since leaving Denver.

When I graduated from residency in 2002, I left Denver with tears in my eyes - I love this place. Peter, Vince, and Lee had actually encouraged me to seriously consider positions outside of Denver and Emory made me an offer I couldn't refuse. I have a longstanding interest in domestic violence and an NIH grant has allowed me to work on a computerized screening project which is designed to screen emergency department patients for depression, suicidality, PTSD, and domestic violence while they're in the waiting room.  I have quite a bit of protected time for my research, but I still do clinical shifts and teach the residents.  Additionally, I serve as the research director for all three of our hospital emergency departments and I coordinate our  journal club. I hold a joint appointment with the Rollins School of Public Health where I teach several courses as well. I'm also the associate director of the Center for Injury Control.

When do you sleep?

Believe it or not, I'm really a normal person.

A lot of other questions obviously stem from your first answer. Tell me more about your domestic violence research.

This has been a longstanding research interest of mine. I started working on projects regarding this topic early in medical school and it just progressed from there. In fact, when I was a fourth year medical student, I emailed Jean Abbott at the University of Colorado and told her I would be interested in doing research with her. I did a clinical rotation at Denver Health and then also worked with Jean on research surrounding the mandatory reporting law.  We ended up writing about ten papers over the course of my residency.

Explain how the computerized screening system works.

I have three full time research staff who approach patients in the Emergency Department waiting room.  They approach patients who are there, usually for reasons completely unrelated to any psychiatric diagnosis - med refills, and so forth.  These patients give informed consent and then are brought back to a semiprivate computer kiosk where they're asked a variety of questions related to domestic violence, depression, suicidal ideation and other similar topics.  We use validated tools which provide objective scores regarding their risks.  The computer program also is able to adjust to the patient's responses in real time - for instance, a person who has not been in a relationship for over a year is not asked to continue answering questions regarding a nonexistent partner.  At the end of the questions, which usually take about ten minutes to complete, three reports are generated.  One report is a concise summary which is placed on the patient's chart for the ED physician to review.  Another report goes to the research staff who can immediately determine if there are emergent risks such as suicidality which need to be immediately addressed.  Believe it or not, this kiosk system has picked up patients with significant suicidal risks who came to the ED with a completely different chief complaint.  Finally, the patient is given a summary printout and, depending on their responses, they receive a list of follow up resources.

So you've actually taken on two challenges: implementing new technology and meeting the psychosocial needs of patients in a busy emergency department.  Have those two aspects actually been complementary to one another?

Absolutely.  With regards to the technology, the average patient seen at Grady Memorial Hospital has a fourth to fifth grade reading level, yet the computerized kiosk has never been a problem for them.  In fact, we've found that patients are more open in answering questions posed to them by the computer than they would be if a person asked the same set of questions in a face to face interview.  It also addresses the time crunch we all face in the emergency department.  Physicians don't have the time to sit down and do all these screens on their patients, but with this system that process is completed before the patient gets to the room and the doctor sees a concise summary of these psychosocial needs and risks.

I understand that you're the chair of the SAEM national meeting.  How did that come about?

It's just like anything else in medicine.  You jump in early, get involved, and find a mentor.  I've been going to the ACEP and SAEM meetings since my second year of medical school.  I started off as the resident member of the SAEM board of directors and then was appointed to the SAEM Program Committee.  Through this process I worked with Judd Hollander and he basically prepared and mentored me for the chair position over the past several years.

How did you decide to come to Denver Health for residency training?

When I was in my third and fourth year of medical school, I started ripping out articles from the emergency medicine journals and I couldn't help but note the number of studies being published by the faculty at this program.  I also took note of the faculty speaking at the national conferences where the Denver program was always well represented.  It was evident that this program trained leaders in academic emergency medicine and could foster my career development.

Did you rotate at Denver Health as a fourth year student?

I did and I knew right away this was where I wanted to go.  It just clicked for me.  I remember coming back in January and telling Lee Shockley that I was very interested in coming here - he still wouldn't tell me anything but this was obviously my first choice.

Art Kellermann, the director of Emory University emergency medicine described you as "the most promising emergency medical trainee of your generation." Obviously that's a great credit to you, are there people who have been integral in your career development.

Absolutely.  The entire faculty in the Denver program is spectacular and each one contributed uniquely to my career development.  The clinical training here is really unsurpassed.  I told Peter Pons earlier today that his voice is still in my head.  He's just a great clinician who still affects how I practice today.  Steve Lowenstein is a methodologic genius who helped me construct my research.  Jean Abbott was a great partner in several research projects as I mentioned above and always reminded me to maintain balance in my life and Lee Shockley was a great resource when I was looking at different career options.

Many alumni talk about the "DG way" or the "Denver way".  How do you describe that phenomenon?

The Denver way is a philosophy of care.  It's a dividing line between acceptable and unacceptable care which manifests itself in small and big ways.  Do we accept an oral temp or do we insist on a rectal temp?  Do we recognize a potential ectopic early on and treat it like a true life threat or send the patient to radiology for an ultrasound where she can't be monitored and might decompensate?  It's having Peter Pons' voice in your head.  I still remember Peter's inevitable overhead page to the trauma desk if you strayed too far from that philosophy.

Applicants are often focused on choosing between a three year and four year program.  What are your thoughts on that?

I think all EM residency programs should be four years, although many 3 year programs have been able to offer excellent training.  Internal medicine training is three years, pediatrics is three years.  We presume to care for patients of all ages with varying presentations, so we shouldn't abbreviate the training associated with that responsibility.  When you are talking about the rest of your life, one additional year is really not such a great burden.  The fourth year is worth more than the sum of its parts.  It allows you to refine your clinical practice as well as branch out into research and other interests more extensively.

Are there any particular moments or patients that you still remember from residency?

I remember a little girl who came in after an automobile-pedestrian collision.  She had distinct tire tracks across her body.  She ended up having an atlanto-occipital dislocation - so she didn't make it.  I cried after that case which was a little unusual for me.  I think it was actually reassuring to realize that despite everything I had seen up to that point, I still was human and I could be emotionally involved even as I continued to serve as the girl's physician.

What advice would you offer to residents at each level of their training?

I would tell the interns to focus on finding the right work/life balance.  Then once they've determined that balance, they can start exploring research interests and establish relationships with clinical and research mentors.  Hopefully they can get involved with a project during that first year.  Clinically, interns should focus on discerning between sick versus not sick patients.

Second year residents should definitely get involved with a research project if they didn't start one as an intern.  They should try to attend a national meeting - ACEP or SAEM - and become a committee member in one of the national emergency medicine organizations.  They should focus on solidifying their basic approach to trauma and refining their procedure skills.

EM-3 residents should be involved in actual publication regarding their research.  They should be moving up in the national committees with an eye on a leadership position.  At the state level, there are numerous opportunities within Colorado ACEP.  This exposes you to other ED physicians who are decision-makers in their field.  These contacts can offer a perspective from outside the immediate confines of the residency program.  From a clinical perspective, third year residents should focus on running traumas and handling multiple sick patients simultaneously.

Fourth year residents need to decide between fellowship opportunities and attending positions.  They should start the job search early.  I did all my interviews in September which is pretty early but certainly by January you should be looking at specific jobs.  The senior position at Denver Health is the main clinical focus of fourth year and will force you to work on running a department.

Did you feel like the senior position prepared you well for your role as an attending?

Not only did it prepare me well, I quickly realized when I was interviewing for positions that my job as a senior resident at Denver Health was probably harder than most attending positions out there.  The interviewer would warn me that I'd be supervising multiple residents at once and maybe answering paramedic calls as well.  In comparison to the senior responsibilities of a constantly ringing biophone, taking radiology reports, dealing with obs unit issues, and supervising six students and two junior residents, the attending positions sounded relatively benign.

What do you miss about Denver?

I used to go to Little Ollie's and the Tattered Cover in Cherry Creek all the time.  I loved Washington Park and I learned to ski during residency.  I also miss grabbing drinks with colleagues after shift at Governor's Park or Racines.

Where do you see yourself in five years?

I'd like to be the chair of an emergency medicine department.  I'd also consider working as a director within a federal agency like the CDC.

Would you consider coming back to Denver?

Sure.  This program has a legacy that should be continued.  The residents here work with some of the true founders in the specialty.  There aren't many emergency medicine residencies where you work with attendings who have been on staff for twenty years.  Most residencies aren't even that old.  I'd love to be a part of that legacy.